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PASTOEAL  MEDICINE, 


BZ 


DR.  CARL  CAPELLMANN, 

PRACTISING  PHYSICIAN  AT  AIX-LA-CHAPELLE. 

XBANSIiATED, 

WITH  THE  AUTHOR'S  SANCTION, 

BY 

EEV.  WM.  DASSEL, 

Pastoe  op  St.  Maby  Magdalene's  Chubch,  Honesdale,  Pa. 


NEW  YORK  AND  CINCINNATI: 

FB.    PUSTET, 

Peinter  to  the  Holt  Apostolic  See  and  the  Sacked  Conoeboatioh 

OF  Kites. 

1879. 


€22^273)C 


LOAN  STACK 


Entered  according  to  the  Act  of  Congress,  in  the  year  1879, 

By  E.  STEINBACK; 
In  the  OflBce  of  the  Librarian  of  Congress,  at  Washington. 


Stereotyped  and  Printed  at  the 
Boyb'  Pboteotobt, 
West  Chester,  New  York.    V 


BV4335 
G52JZ 


PEEFACE. 


The  favoraole  notices  of  the  work  I  have  attempted  to  translate  which 
have  appeared  in  the  German  reviews,  its  intrinsic  value,  and  its  eminent 
practical  usefulness,  inspired  me  with  the  desire  to  open  for  it  a  wider 
sphere  of  usefulness,  by  clothing  it  in  an  English  dress. 

The  author  is  Dr.  Carl  Capellmann,  an  eminent  German  physician 
practising  in  Aix-la-Chapelle.  His  treatise,  "  De  occisione  foetus,"  brought 
him  a  great  reputation  among  theologians  and  physicians,  and  he  was 
strongly  urged  to  publish  a  book  on  "Pastoral  Medicine."  In  deference  to 
this  request,  this  present  work  appeared  in  Easter,  1877.  A.  second 
edition  was  called  for,  in  August  of  the  same  year,  and  a  third  in  the  spring 
of  this  year. 

The  task  of  translation  has  been,  for  obvious  reasons,  a  most  unwelcome 
one.  A  large,  and,  perhaps,  the  most  important,  portion  of  Dr.  Capell- 
mann's  work  treats  of  subjects  connected  with  the  faithful  observance  or 
criminal  breach  of  the  sixth  commandment.  The  calamitous  consequences 
of  the  latter  to  soul  and  body  alike  cannot  be  exaggerated.  The  moral 
and  physical. ills  it  brings  in  its  train  are  so  complicated  with  one  another, 
that  it  is  impossible  to  treat  them  apart  ;  and  this  compels  both  the  moralist 
and  the  physician  to  enter  into  details  of  the  most  repulsive  description. 
But  neither  the  one  nor  the  other  should  be  deterred  from  his  duty  of 
treating  subjects  of  so  painfully  unpleasant  a  nature,  when  it  is  a  question 
of  alleviating,  still  more  of  curing,  the  raoral  and  physical  miseries  of  his 
fellow-creatures.  If  the  exigencies  of  our  work  force  us,  at  the  bidding  of 
holy  charity,  to  lay  bare  some  of  the  hideous  vices  which  degrade  humanity, 
and  afflict  it  with  its  most  frightful  sufferings,  we  shall  receive  the  sym- 
pathy of  all,  save  those  conspirators  against  God  and  the  dignity  of  the 
human  being  who  have  neither  loathing  for  vice,  nor  sympathy  for  suffering. 

It  may  be  doubted  whether  or  not  it  would  be  advisable  to  conceal  the 
treatment  of  such  subjects  under  the  disguise  of  a  dead  language.  On  the 
whole,  I  subscribe  to  the  opinion  of  the  author,  pages  69  and  70,  who  is  in 
favor  of  the  vernacular,  following  thereby  the  example  of  the  Rev.  J.  C. 
Debreyue,  a   distinguished   physician,  who,  in  obscurity  at  La  Trappe, 


991 


IT  PREFACE. 

made  a  happy  use  of  his  vast  stores  of  medical  knowledge.*  A  perfect 
familiarity  with  the  dead  languages  is  a  less  common  accomplishment  now- 
adays than  formerly  ;  and  in  a  treatise  of  so  essentially  practical  a  nature, 
requiring  the  utmost  precision  of  expression,  and  wherein  the  slightest 
misunderstanding  might  have  the  most  serious  results,  there  would  appear 
to  be  almost  a  necessity  for  choosing  the  vernacular  language  as  the 
vehicle  of  information. 

As  the  work  is  addressed  exclusively  to  priests  and  physicians,  I  have 
endeavored,  with  the  author,  to  lessen  the  disgust  necessarily  provoked  by 
unavoidable  details,  by  putting  them  into  a  Latin  disguise,  when  that 
could  be  done  without  any  risk  of  misunderstanding. 

Nevertheless,  I  reiterate,  most  earnestly  and  solemnly,  that  the  work  is 
intended  wholly,  exclusively,  and  entirely,  for  the  professional  use  of  whether 
priest  or  physician,  and  that  it  is  altogether  unfit  for  the  perusal  of  the  lay 
or  general  reader ;  as  indeed  must  all  works  be,  treating  of  similar  subjects. 

With  regard  to  the  translation  itself,  I  have  endeavored  to  make  it  a 
faithful  rendering  of  the  original.  At  first,  indeed,  I  had  contemplated 
making  sundry  alterations  and  additions,  such,  for  example,  as  would 
naturally  be  suggested  by  a  difference  of  country,  customs,  climate,  etc.,  etc. 
But  since  the  work  is  likely  to  find  readers  wherever  the  English  language 
is  spoken,  I  thought  it  best  to  leave  Dr.  Capellmann's  work  unaltered, 
trusting  to  the  good-sense  and  judgment  of  individual  readers  to  make  any 
indispensable  modifications  suggested  by  the  conditions  we  have  referred  to. 

If  this  work  should  prove  of  some  practical  service  to  my  clerical 
brethren,  and  to  Christian  physicians  who  make  a  ministry  of  their  art,  the 
somewhat  difficult,  and  sometimes  disagreeable,  task  of  its  translation  will 
not  have  been  undertaken  in  vain. 

Wm.  DASSEL. 
HONESDALE,  Pa.,  December,  1878. 

*  Debreyne,  P.  J.  C,  "  Essai  sur  la  theologie  morale,  considerie  dans  ses  rapports  avee 
la  physiologie  et  la  midecine,"  V.  idilion,  Paris,  librairie  Poussielgue  frirei,  ru€ 
CatsttU  27.  1868. 


In  whatever  is  written  in  this  work,  it  has  been  my 
intention  to  be  in  complete  accord  with  the  doctrines  of 
the  Holy  Roman  Catholic  Church.  Should  anything  have 
been  inadvertently  advanced  ever  so  little  at  variance 
with  them,  I  recall  and  disavow  it;  by  anticipation,  uncon- 
ditionally. 

THE  AUTHOR. 


INDEX. 


Preface        -        --       -        -        -•--.        -        -        -        iu-iv 

Introduction     .-.-------•  1 

A.  The  Fifth  Commandment. 

I.  Artificial  Abortion  and  Perforation  of  the  living  Foetus  in 

order  to  save  the  mother  ------    10 

1)  Abortion 10 

2)  Perforation  of  the  living  Foetus      -----     17 

II.  Operations  attended  with  risk  to  life  -----        20 
III.  On  the  use  of  medicines  -------21^ 

Morphia     ----------31 

Chloroform    ----------36 

Animal  Magnetism     --------40 

Appendix:  Vaccination      ---------42 

On  wet-nurses  --------45 

Intemperance,  drunkenness  -------52 

Hysteria 5<> 

Hypochondriasis  --------59 

Ecclesiastical  sepulture  of  suicides     -----        60 

Mental  diseases     ---------64 

B.  The  Sixth  Commandment     -------69 

I.  Masturbation         ---------70 

II.  Pollutions ---81 

III.  Usus  matrimonii    ---------89 

1)  Onanism    ---------89 

2)  Abruptio  copulae  ante  seminationem^    -        -        «       -     93 

3)  Situs  conjugum  in  copula         -        -        -        -        -        104 

4)  Copula  in  certain  conditions  -----  105 

a)  Menstruationis  tempore         -----        106 

b)  Purgationis  tempore  -------  107 

o)  Laotationis  tempore      ------        109 


riii  INDEX. ' 

>A»«. 

d)  Praegnationis  tempore       -       -       -~-       •       -110 

e)  Morbi  tempore      -        -        -        -        -        -        -        113 

f)  Tempore  statim  post  balneum,  sectionem  venae,  rel 

prandium  aut  coenam      ------  Hg 

rV.  Tactus  et  aspectus  impudici         -.-_..         II7 

C.  Tlie  Commandments  of  the  Church 123 

I.  Church-going      ---------        123 

II.  Fasting 126 

III.  Abstinence  ---- 131 

D.  The  Sacraments       '- 137 

I.  Baptism 137 

II.  Holy  Communion    ---------  155 

III.  Extreme  Unction        -        -        -        -        -        -'-        -        165 

Duty  of  the  physician  in  danger  of  death,  etc.        -        _        -  167 

IV.  Matrimony  (de  impotentia)  ------         173 

"E.  Affections  and  diseases  dangerous  to  life      -        .        .        .  181 

F.  Symptoms  of  danger --        185 

G.  The  agony 195 

H.  Cases  of  apparent  death      -------        198 

J.  Signs  of  death 201 

K.  Emergencies      ----------  206 

I.  Rules  for  restoring  life        -         ------        207 

n.  First  help  in  sudden  attacks  of  illness      -        -        -        -        -211 

in.  Lesions       -        - 218 

IV.  Cases  of  poisoning ---.  226 

Ii.  Nursing  the  sick  ---------        231 

I.  The  siek-roora 236 

II.  The  sick-bed 238 

III.  Bed-sores 240 

IV.  Fumigations -        -       242 

V.  Articles  of  diet  for  the  sick-room      ------  244 

VI.  Administration  of  medicines         -  -        -        -        -        -        247 

VII.  Local  applications  -.-        -  -        -        -        -        -        -  249 

VIII.  Miscellaneous  (Temperature,  etc.)  -----        258 

IX.  Nursing  during  the  last  moments  ------  260 


The  following  editions  of  hand-books  of  Moral  Theology  are  quoted: 

Gliry^  Compendium  Theologiae  Moralis,  Antonii  Ballerini  adnotationibus 

locupletatum.     Editio  tertia.     Romse  :  1874-76. 
S.  Alplionsi  de  Liigorio,  Theologia  Moralis,  curavitP.  Mich.  Heilig. 

Mechliniffi  :  1852: 

ScaTini,  Petr.,  Theologia  Moralis  Universa.   Editio  tertia  Parisienais 
Pariaiis  :  1859. 


CAPELLMAM'S 

PASTORAL  MEDICINE. 


INTRODUCTION. 

A  HAND-BOOK  of  "  pastoral  medicine  "  is  a  want  that  has 
long  been  felt  by  the  clergy  in  the  care  of  souls.  The 
appearance  of  such  a  work^  therefore,  needs  no  apology, 
but  opinions  may  be  divided  as  to  what  it  should  contain. 

In  my  view,  pastoral  medicine  is  the  sum  of  those  expla- 
nations anatomical-physiological,  as  well  as  pathological- 
therapeutical,  a  knowledge  of  which  is  necessary  to  the 
priest  in  the  exercise  of  his  pastoral  functions. 

I  prefer  to  extend  the  scope  of  pastoral  medicine  so  as  to 
meet  likewise  the  exigencies  of  physicians.  Consequently, 
it  will  be  my  aim,  in  this  work,  to  communicate  to  physicians 
those  dogmatical  and  moral  principles,  a  sufficient  know- 
ledge of  which  is  indispensable  to  render  their  professional 
acts  always  safe  and  consistent  with  Christian  morals. 

To  ail  appearances,  physicians  nowadays  do  not  feel 
the  need  of  becoming  acquainted  with  those  principles 
and  teachings  of  theology  which  have  a  bearing  on  their 
profession ;  at  least  not  so  much  as  priests  feel,  on  their 
part,  the  necessity  of  obtaining  that  amount  of  medical 
knowledge.  The  need,  nevertheless,  exists,  and  it  would 
be  manifested  but  for  the  materialism  now  prevalent  in 
medical  science.     Priests  are  often  at  a  loss   to   decide 

1 


2  INTRODUCTION. 

some  moral  questions,  because  they  have  no  knowledge,  or 
an  insufficient  one,  of  physiological  and  pathological  details. 
Physicians,  likewise,  are  apt  to  do  violence  more  or  less  to 
their  own  conscience,  or  that  of  their  patients,  through 
a  lack  of  knowledge  of  certain  positive  teachings  and 
principles  of  moral,  and  even  dogmatic,  theology.  Students 
of  medicine  have  little  time  to  add  the  study  of  theology 
to  that  of  their  own  science,  and  still  less  opportunity  of 
doing  so  at  our  universities,  even  if  they  were  so  inclined. 
It  must  be  also  deeply  regretted  that  the  theoretical, 
and,  not  unseldom,  the  practical  instructions  given  at  our 
universities  are  often  at  variance  with  good  morals. 

Lectures  upon  medical  jurisprudence  are  delivered 
both  to  law-students  and  students  of  medicine,  and"  the 
books  thereon  are  arranged  to  enable  both  lawyer  and 
physician  to  gain  all  necessary  information  about  a  science 
which  is,  otherwise,  foreign  to  each  respectively.  In  the 
same  manner,  pastoral  medicine  should,  in  my  opinion, 
meet  the  exigencies  of  both  priest  and  physician,  the  more 
so  as  the  questions  at  issue  cannot  be  clearly  determined, 
unless  theology  and  medicine  mutually  complete  each 
other.  It  is,  of  course,  unavoidable  in  such  a  work  to  treat 
on  matters  that  were  well  known  before,  either  to  the  priest 
or  to  the  physician. 

The  nature  of  my  subject  does  not,  however,  require 
me  to  treat  systematically  all,  or  nearly  all,  the  branches 
of  medical  science  in  a  popular  form,  any  more  than  to 
write  a  systematic  treatise  on  the  whole  of  Dogma  and 
Morals.  If  it  were  otherwise — if  a  work  on  pastoral 
medicine  demanded  an  elaborate  treatment  of  both  the 
sciences  on  which  it  touches,  a  multitude  of  quartos  would 
scarcely  suffice  for  it,  instead  of  a  volume  of  the  modest 
pretensions  of  the  present.     No  one  would  think  it  within 


INTRODUCriOX.  3 

the  scope  of  a  book  on  medical  jurisprudence  to  give,  in  a 
chaptei-  on  infanticide,  a  systematic  treatise  on  obstetrics, 
or  a  detailed  discussion  of  the  laws  and  juridical  views  on 
murder  and  manslaughter.  It  is  enough  to  convey  just  so 
much  information  as  is  indispensable  for  the  immediate 
object  in  view ;  anything  more  is  supererogatory.  This 
fault  of  overloading  the  work  with  scientific  detail  mars 
nearly  all  books  on  pastoral  medicine  that  have  hither- 
to appeared.  Systematic  treatises  on  anatomy,  physi- 
ology, dietetics  of  body  and  soul,  semiotics,  pathology  and 
therapeutics,  even  whole  sections  of  pastoral  theology, 
were  jumbled  together.  Of  these  branches  some  have  no 
fitting  place  in  pastoral  medicine,  because  physician  and 
priest  ought  to  have  a  thorough  acquaintance  with  them. 
Psychology,  for  instance.  This  science  in  our  ^^  philo- 
sophical century "  is  much  sinned  against,  and  does  not 
receive  proper  attention  from  many  a  phj^sician,  nor  even 
from  many  a  priest ;  but  it  is  beyond  the  limits  of  pastoral 
medicine  to  correct  this  defect.  In  the  same  category 
with  psychology  may  be  placed  dietetics  of  the  body  and 
soul.  Every  intelligent,  educated  man  is  expected,  in 
his  own  interest,  to  inform  himself  on  the  method  of  living 
best  suited  for  health  of  body  and  health  of  soul.  But 
the  obligation  is  still  more  binding  on  priests  and  physicians 
who  have  not  their  own  welfare  only  to  consider,  but  who 
are  intrusted  also  with  the  care  of  the  souls  and  bodies 
respectively  of  their  fellow-men.  To  be  a  physician  whether 
for  body  or  soul,  something  more  is  required  than  mere 
prescriptions  or  attempts  at  conversion.  To  preserve  the 
health  of  both  is  of  far  greater  importance  than  to  restore 
it.  The  science  of  dietetics,  consequently, — a  knowledge 
of  which  is  demanded  by  the  very  offices  of  both  priest 
and  physician, — does  not  come  within  the  legitimate  sphere 


4  INTRODUCTION. 

of  pastoral  medicine.  The  same  cannot  be  said  of  dietary 
nursing  of  the  sick ;  regarding  which  the  information 
necessary  for  a  priest  must  be  given,  as  he  may  do  a 
great  deal  of  good,  especially  in  the  country,  by  removing 
prejudice,  reforming  abuses,  or  by  keeping  off  noxious 
agents.  For  he  generally  visits  the  sick  as  often  as  the 
physician,  sometimes  oftener,  and  may  be  of  service  at  times, 
in  controlling  somewhat  the  injudicious  nursing  of  relatives. 

In  regard  to  anatomy  and  physiology,  it  would  be  very 
useful  for  every  intelligent  man  to  have  some  knowledge  of 
his  body  and  his  functions,  in  order  to  have  a  clearer  idea 
how  to  live  according  to  the  laws  of  health.  For  priests 
such  a  knowledge  is  almost  a  necessity.  But  it  is  not 
the  province  of  a  work  on  pastoral  medicine  to  impart 
that  knowledge.  There  are,  within  easy  reach  of  all, 
numbers  of  popular  medical  treatises  on  this  and  other 
kindred  subjects,  which  contain  all  that  is  necessary  to  be 
known  of  them.  To  treat  such  matters  in  the  somewhat 
aphoristic  way  that  would  be  required  to  restrain  them 
within  the  limits  of  pastoral  medicine,  would  be  likely  to 
leave  them  unintelligible  and  obscure.  Pastoral  medicine 
has  to  confine  itself  to  matters  absolutely  necessary  for 
a  priest  in  his  vocation.  Some  of  the  facts  and  results 
have  of  course  to  be  accepted  without  an  erudite  scientific 
investigation,  as  the  saying  is,  ^^  in  verba  magistri.'^^  This 
must  always  be  the  case,  if  one  cannot  make  a  study  one^s 
self  of  a  science.  Were  it  otherwise,  the  different  branches 
of  science  would  be  of  comparatively  little  value  ;  since  no 
one  can  for  himself  study  and  master  all  science. 

The  same  may  be  said  of  pathology  and  therapeutics. 
All  that  is  necessary  to  be  known  of  them  by  the  priest  is 
how  to  recognize,  in  general,  danger  of  death ;  what 
diseases  and  sudden  seizures,  more  or  less  known  to  him. 


INTRODUCTION.  5 

are  dangerous,  and  how  to  act  in  sudden  emergencies. 
He  will  then  be  able  to  judge  of  the  proper  moment  for 
administering  the  last  sacraments,  so  as  not  to  be  under 
the  necessity  of  remaining  inactive  and  unadvised  before 
the  physician's  arrival.  Having  urged  the  desirableness 
of  a  wider  dissemination  of  a  knowledge  of  dietetics,  and 
even  of  anatomy  and  physiology,  I  am  compelled  to  dis- 
courage the  study  of  pathology  and  therapeutics  on  the 
part  of  the  clergy.  I  am  well  aware  that  I  touch  a  sore 
point  here,  but  1  do  so  unshrinkingly. 

That  educated  as  well  as  uneducated  persons  should  be 
fond  of  speaking  and  thinking  of  medical  subjects,  is  only 
natural.  Health  is  the  greatest  of  all  possessions  next  to 
life,  and  it  is  only  to  be  expected  that  every  man  should 
take  a  deep  interest  in  whatever  concerns  health  and  its 
recovery.  But  to  judge  dogmatically  of  medical  matters 
without  any  previous  study  is  quite  another  thing,  and  is 
quite  unpardonable,  especially  in  men  of  education,  who 
do  this  nowadays  with  an  audacity  and  obstinacy  almost 
inexplicable.  If  their  shoes  are  to  be  mended,  they  go  to 
the  shoemaker,  because  they  know  very  well  that  they 
cannot  do  it  themselves,  not  having  learned  the  trade. 
But  a  bodily  disorder!  ^^My  dear  friend,  that's  quite  a 
different  thing.  A  living  body  is  not  a  shoe  !"  Any  rent 
in  a  shoe  is  plainly  visible  and  is  only  material  j  but  the 
disorder  in  a  living  body  cannot  always  be  seen  or  felt ; 
there  may  be  no  material  change  ;  it  may  be  produced  by 
functional  perturbations,  the  primitive  cause  of  which  lies 
somewhere  else  than  in  that  organ  or  member  whose 
functions  appear  to  be  disturbed.  The  organization  of  a 
living  body  is  the  most  complicated  work  of  the  whole 
creation  ;  and  this  is  why  even  men  of  known  ability  and 
recognized  competence^    of  sound  judgment,  employing 


6  INTKODUCTION". 

the  best  methods  of  investigating  disease,  and  taking  the 
greatest  care,  are  sometimes  not  able  to  find  out  in  the 
living  body  the  real  cause  of  perturbations  that  threaten 
life.  This,  however,  does  not  hinder  men  who  may  chance 
to  have  had  ever  so  little  education,  from  giving  their 
opinion  on  the  subject.  If  they  have  only  glanced  over  some 
popular  medical  treatises  of  the  trash-literature  of  the  day, 
then  they  imagine  themselves  competent  to  judge  of  the 
cause  and  nature  of  a  disease,  to  prescribe  the  proper 
remedies,  and  to  speak  of  the  treatment  employed  by 
the  physician  in  the  most  contemptuous  manner.  Even 
^'  experiences  '^  are  quoted  by  non-professional  men,  with- 
out any  pretension  to  education,  in  support  of  wrong  views, 
and  in  opposition  to  the  authority  of  learned  practitioners. 
Such  a  remark  as  this,  "  I  have  seen  a  case  the  same  as 
yours  get  well  directly  by  a  very  different  treatment ;  "  or, 
^^  That  disease  passed  off  without  the  -use  of  medicine,"  is 
often  heard.  A  disease  may  be  cured,  of  course,  by  the 
operation  of  nature  without  the  interposition  of  medical 
remedies  j  but  that  very  same  disease  may  just  as  well  lead 
to  death  or  to  chronic  sickness,  by  a  complication  of 
functional  derangements  not  visible  to  unprofessional  eyes. 
Firmly  believing  in  '^post  Jioc^  ergo  propter  hoCj^  they 
overlook  the  healing  power  of  nature,  which  may,  in  many 
organisms,  in  spite  of  erroneous  diagnosis  and  wrong  treat- 
ment, be  strong  enough  to  overcome  the  disturbance  caused 
by  the  disease  and  by  the  use  of  wrong  medicines.  But 
their  *^  experiences,'^  as  they  call  them,  are  to  them  suf- 
ficient proof  of  the  correctness  of  their  idea  of  the  malady 
and  its  proper  treatment.  Quacks,  medical  humbugs, 
patent  medicines  included,  are  fostered  and  encouraged 
by  such  people.  Apart  from  the  money  thus  foolishly 
squandered,  the  lamentable  fact  remains  that  thousands 


INTRODUCTION.  7 

are  rendered  chronic  invalids  through  such  folly,  less 
perhaps  from  using  remedies  improper  in  themselves,  than 
for  want  of  proper  treatment. 

For  this  reason  alone,  persons  outside  of  the  profession 
had  better  leave  medical  books  alone  ;  the  more,  as, 
through  such  studies,  the  condition  of  their  own  body  is 
forcibly  impressed  upon  them.  Often  has  experience 
proved  that  even  members  of  the  medical  profession,  men 
of  known  ability,  and  of  many  years,  practice,  lose  all 
sound  judgment  with  regard  to  the  state  of  their  own  health. 
Beginners  in  medical  science  are,  of  course,  the  most 
amenable  to  this  weakness.  When  I  studied  at  Wiirzburg, 
Professor  Bamberger  related  that,  in  each  term,  after 
the  lectures  on  a  certain  class  of  diseases,  especially 
heart  diseases,  a  great  many  students  applied  to  him 
to  be  thoroughly  examined.  They  imagined  that  they 
had  discovered  in  themselves  many  of  the  symptoms 
enumerated  in  the  lectures  and  text-books.  The  morbid 
conditions  and  dispositions  they  thought  themselves  subject 
to,  proved,  of  course,  on  a  slight  examination,  to  exist  only 
in  a  morbid  imagination.  Naturally,  men  outside  of  the 
profession,  would-be-doctors,  who  gain  their  pseudo-wisdom 
from  incomplete  and  ill-understood  treatises,  are  still  more 
apt  to  be  deceived  and  misled  by  such  symptoms  as  every 
one  of  them  fancies  himself  to  have  found  in  his  own 
constitution.  Experience  proves  this  fact.  The  study  of 
medical  books  is  arraigned  as  one  of  the  principal  causes 
leading  to  the  widespread  malady  of  hypochondriasis  by 
nearly  all  writers  thereon.  When  medical  books,  popular  or 
not  popular,  are  found  in  the  possession  of  hypochondriacs, 
as  is  generally  the  case,  the  physician  will  order,  as  a  first 
step  toward  the  attempted  cure,  a  holocaust  to  be  made  of 
all    of  them.      Essays   on   pathology   and   therapeutics. 


8  INTRODUCTION. 

therefore,  necessarily  only  half  understood,  cannot  but 
be  of  harm  to  the  general  reader  5  and,  for  this  reason, 
dissertations  thereon  should  not  be  contained  in  a  work  on 
pastoral  medicine.  Such  a  Avork  should  confine  itself  to 
giving  the  necessary  information  how  to  render  immediate 
assistance  in  sudden  emergencies  5  the  more  so,  as  priests, 
especially  in  rural  districts,  are  rather  tempted,  by  urgent 
entreaties,  to  play  a  little  the  part  of  a  doctor,  mostly  in 
a  harmless  manner.  Nowadays  the  services  of  a  physician 
can  almost  everywhere  be  secured  without  any  difficulty. 
Such  attempts,  therefore,  on  the  part  of  priests,  are  not  to 
be  encouraged.  They  should  reject  all  requests  of  this 
kind,  because  their  vocation  is  to  instruct  the  people ;  and 
it  is  their  duty  to  oppose  all  prejudices,  quackeries,  and 
superstitions.  He,  the  priest,  should  rather  convince  the 
people  how  they  are  bound  in  conscience  to  apply  to  a  com- 
petent physician.  Of  course,  when  asked  to  recommend 
a  physician,  he  must  be  guided  by  pastoral  prudence. 

The  objection  will  be  made  to  me,  and  has  been  made 
to  many  physicians,  that  such  reasoning  smacks  too  much 
of  egotism.  I  will  answer  with  a  commonplace.  Physi- 
cians are  bound  to  give  that  counsel  which  is  best  suited 
to  preserve  to  their  patients  health  and  life.  Supposing  a 
man  has  a  sore  leg, — if  an  amputation  is  performed,  the 
patient,  according  to  the  conviction  of  the  doctor,  may 
recover  j  if  not,  he  will  die  after  a  few  days.  For  perform- 
ing that  amputation  the  physician  will  receive  a  large  fee  ; 
but  none,  or  a  much  smaller  one,  if  he  does  not  perform  it. 
To  advise  the  amputation  conscientiously,  lays  him  open  to 
the  charge  of  acting  in  his  own  interest,  just  as  much  as 
to  counsel  a  patient  to  employ  a  competent  physician,  and 
not  a  quack,  on  the  honest  conviction  that  he  will  fai-e 
better  with  the  first 


INTRODUCTION.  9 

•  It  may  be  objected  that  there  is  no  necessity  to  touch 
this  question.  I  am,  however,  of  the  opinion  that  such 
points  should  not  be  left  undecided.  I  have  purposely 
entered  into  this  discussion  to  make  it  clear  why  I  have 
not,  as  some  other  writers  on  pastoral  medicine  have  done, 
supplied  any  information  which  could  enable  the  priest 
to  act  the  part  of  a  physician.  The  physician,  on  the  other 
hand,  should,  for  still  more  cogent  reasons,  avoid  assuming 
the  place  of  the  priest.  For  this  reason,  he  will  find  in 
this  book  remarks  and  hints  only  on  such  matters  of  moral 
theology  as  he  ought  to  have  before  his  mind,  in  order 
not  to  neglect  the  spiritual  welfare  of  his  patients,  and 
always  to  act  for  himself  in  conformity  with  the  dictates 
of  Christian  morals. 


A —THE  FIFTH  COMMAlsDMENT. 

I. — ARTIFICIAL     ABORTION     AND     PERFORATION      OF      THE 

LIVING   F(ETUS   IN   ORDER   TO  SAVE   THE   LIFE   OF 

THE   MOTHER.* 


l._ABORTION. 

To  Christian  civilization  belongs  the  merit  of  having 
first  prohibited  artificial  abortion  as  a  remedy,  and  of 
having  nearly  eradicated  its  employment.  At  the  close 
of  the  last  century,  the  English  earned  the  doubtful  merit 
of  having  introduced  it  again  among  obstetric  operations. 
The  French  followed,  as  did,  after  some  reluctance,  the 
German  accoucheurs.  Jaquemier  writes,  1867  :t  ^' Au- 
jourdlmi  qiCon  ii'Msite  phis  a  interromper  des  ses  premieres 
phases  une  grossesse,  qui  7i^eut  pu  arriver  a  son  terme  smis 
mettre  en  danger  la  vie  de  la  femme  enceinte^  il  n' est  pas  tin 
medccin  digne  dc  ce  nom  qui  consentirait  a  rcster  vohmtaire- 
ment  tin  temoin  inactif^  In  Germany,  Mende,  Kiwisch 
and  Scanzoni  reintroduced  the  operation,  to  whose  in  • 
fluence  it  is  due  that  nowadays  nearly  all  lecturers  and 
writers  on  obstetrics  treat  at  least  of  one  or  the  other 
mode  of  performing  it. 

Abortion  is  the  expulsion  of  the  impregnated  ovum  from 
the  uterus,    at   any   time    during   pregnancy,  before   the 

*  Compare  niv  pamphlet,  "De  occisione  foetus,^'  qiiam  ahortu  provocato, 
pcrfordtione,  cepkalotrlpsia  medici  undent.     Aachen  :  K.  Bartli.   1875. 

t  Jaquemier  en  Dictionaire  encyclopedique  des  sciences  medicates.  Paris, 
1867.  Tom.  7,  pag.  575. 


ABORTION.  1 1 

foBtus  has  attained  such  development  as  to  be  capable  of 
life.  By  abortion  the  foetus  is  doomed  to  a  sure  death. 
Artificial  abortion,  therefore,  causes,  as  its  direct  effect, 
the  death  of  the  expelled  foetus :  artificial  abortion  is 
foeticide. 

In  order  to  be  in  a  position  to  pass  a  competent  judg- 
ment on  the  question,  whether  the  provocation  of  abortion 
may  be  allowed  as  an  interposition  of  art  to  accomplish 
delivery,  the  precise  subject  on  which  the  operation  acts 
must  first  be  defined.  This  subject  is  the  impregnated, 
developing,  living  ovum  of  the  human  female.  This  ovum 
must  be  presumed  to  be  living,  as  long  as  ther.e  is  no 
conviction  of  its  death. 

There  is,  of  course,  no  objection  to  expel  a  decayed  foetus. 
But,  as  nothing  can  be  conclusively  presumed  during  preg- 
nancy respecting  the  life  of  the  foetus,  it  must  be  presumed 
to  be  living  ;  if  living,  it  has  a  human  soul.  The  one 
human  soul  is  also  the  vital  principle  of  the  animal  life  of 
man.  There  is  no  reason  to  claim  for  the  human  embryo, 
either  until  its  delivery,  or  before  a  certain  period  of  preg- 
nancy, any  other  principle  of  life ,  or  another  soul ;  qua 
cedentej  as  St.  Thomas  thinks,  *  the  rational  human  soul 
occupies  its  place.  Why  ask  for  a  repeated  activity  of 
the  Creator,  where  one  act  is  sufficient  ? 

The  absence,  relatively  speaking,  the  inactivity,  of  the 
higher  functions  of  the  soul  during  intra-uterine  life,  can- 
not be  regarded  as  an  evidence  against  the  presence  of  a 
rational  soul.  For,  on  the  one  hand,  this  is  explained  by 
the  fact  that  the  organs  of  perception  and  action  are  not 

*  Quaestiones  disputatae,  quaest.  unira  de  anima,  art.  9:  *^  Et  sic,  quum 
in  enihryone  pr'imo  sit  anima  vegetatlva  tantum,  quum  perventum  fuerit 
(sc.  embrj/o)  ad  majorem  perfectionera,  tollitur  forma  imperfecta  et  succedit 
forma  perfeciior,  quae  est  anima  vegetativa  et  sensitiva  simul,  et  ultima 
cedenie  succedit  ultima  forma  completissima,  quae  est  anima  rationalii. 


12  THE   FIFTH    COMMANDMENT. 

developed,  or  are  obstructed  in  their  functions.  On  the 
other  hand,  similar  phenomena  are  of  no  rare  occurrence. 
During  sleep,  swoons,  catalepsy,  etc.,  the  functions  of 
animal  life  are  progressing,  whilst  the  higher  functions  of 
the  soul  are  suspended,  or  at  least  appear  to  be  suspended. 
The  soul  need  not  be  always  acting  in  all  directions :  at 
least  no  conclusion  can  be  drawn  from  the  absence  of  some 
functions  of  the  soul  respecting  the  absence  of  the  con- 
ditions of  these  functions.  The  absence,  therefore,  of  the 
higher  functions  of  the  soul  does  not  justify  the  conclusion 
as  to  the  absence  of  the  rational  soul.  We  must  maintain 
that  the  human  embryo  is  endowed  with  the  rational  soul 
at  the  very  instant  of  conception,  and  that  the  impregnated 
human  foetus  is  an  individual  human  being. 

Each  individual  human  being,  and,  consequently,  the 
impregnated  human  foetus,  has  the  right  to  live.  This 
right  cannot  be  disputed,  unless, 

1,  The  individual  is  deprived  of  it  by  acting  against 
divine  and  human  laws,  or  by  trespassing  on  all  natural 
and  social  order ;   or  unless, 

2.  By  any  unlawful  attack  on  the  body  or  life  of  another, 
this  other  is  justified,  in  self-defence,  to  harm  the  unlawful 
assailant,  even  to  the  depriving  him  of  his  life  in  order  to 
preserve  his  own. 

Ad  1.  The  child,  during  its  foetal  life,  cannot  forfeit  its 
right  to  live  by  acting  against  the  law,  or  by  trespassing 
on  lawful  order,  being  in  total  passivity  by  constraint. 
Nobody  can  deserve  punishment  remaining  passive  or  not 
acting,  when  he  is  deprived  of  the  possibility  of  acting, 
without  any  fault  of  his  own. 

Ad  2.  Neither  can  it  be  maintained  that  the  foetus  acts 
as  unjust  assailant  on  the  well-being  and  life  of  the  mother. 
The  embryo  might  eventually  become  a  source  of  danger 


ABORTION.  13 

to  the  life  of  the  mother,  but  it  becomes  so  involuntarily, 
without  any  action  of  its  own,  without  any  act  of  its  will. 
Thus  '^  unjust  aggression  "  is  completely  absent.  Yet,  this 
element  of  ^^ unjust"  aggression  is  essentially  necessary  to 
justify  a  defence  that  may  extend  to  taking  away  the  life 
of  the  assailant.  But  it  is  exceedingly  doubtful  whether 
a  child,  which  cannot  be  delivered  without  risk  of  death 
to  the  mother,  can  be  considered  an  assailant  at  all.  In 
most  cases  the  hindrance  to  safe  delivery  lies  with  the 
mother,  the  cavity  of  the  pelvis  being  too  narrow,  etc. 
The  act  of  parturition  also  does  not  originate  in  the  child, 
but  in  the  mother.  Through  the  movements  of  the  uterus, 
which,  although  they  are  not  under  the  control  of  the 
mother's  will,  yet  originate  in  her,  the  danger  arises  for 
mother  and  child.  Consequently,  if,  through  a  wilful  act 
of  the  mother  (conception),  the  embryo  has  been  placed  in 
its  uterine  position  ;  if  its  expulsion  from  the  uterus  is  aimed 
at  by  an  action  originating  in  the  mother ;  if  (generally  at 
least)  obstacles  to  this  expulsion  are  seated  in  the  mother : — 
if,  by  these  circumstances,  all  originating  in  the  motter,  the 
lives  of  mother  and  child  are  endangered,  how  can  the  child 
be  called  an  aggressor,  still  less  an  '^unjust  aggressor"? 

The  mother,  therefore,  or  the  physician  acting  for  the 
mother,  cannot  appeal  to  the  principle  of  self-defence. 

Consequently,  artificial  abortion  must  be  regarded  as 
wrongful  killing,  as  murder. 

Murder  is  prohibited  by  divine  and  human  law  j  there- 
fore artificial  abortion  is  prohibited* 

But  are  there  no  cases  in  which  artificial  abortion  may 
become  allowable  ?     We  have  to  distinguish. 

*  Physicians  are  sometimes  asked,  by  persons  pregnant  from  illeo-jrimate 
intercourse,  to  procure  far  them  an  abortion,  in  order  to  save  them  from 
shame.  Tliat  the  physician  can  absolutely  have  nothing  to  do  with  such 
a  request  is  clear;  but  some  physicians  advise  the  avoidance  of  a  bhink 


14:  THE   FIFTH    COMMAXDMEXT. 

1.  Is  it  allowed  to  induce  artificial  abortion  directly^  in 
order  to  avert  a  risk  of  the  mother's  life  ? 

2.  Is  it  allowed  to  induce  it  indirectly^  in  order  to  avert 
that  danger  ? 

Ad  1.  The  moralists  answer :  Nunqiiam  licet  directe 
provocdre  ahortum.  Even  in  order  to  avert  danger  of 
life,  artificial  abortion  cannot  be  allowed.  The  objection, 
that  the  well-being  of  the  mother  is  directly,  the  abortion 
indirectly  only,  intended,  does  not  hold  good.  Except 
in  one  single  case  (see  farther  down),  the  danger  to  the 
mother  is  removed,  only  when  and  because  abortion  en- 
sues. The  salvation  of  the  mother's  life  is  not  the  direct 
and  immediate  result  of  the  remedy,  which  in  itself  may 
have  no  effect  in  that  direction  one  way  or  the  other,  but 
is  employed  to  induce  abortion ;  but  it  Is  the  result  only 
of  the  abortion  procured.  Any  good  effect  directly  intended 
should  not  result  from  any  forbidden  effect  which  is  the 
cause  of  the  former,  for  then  this  forbidden  effect  is  neces- 
sarily directly  intended. 

Ad  2.  Abortion  would  be  indirectly  induced,  if  means  are 
employed  which  appear  necessary  or  useful  to  avert  danger 
to  the  mother's  life,  but  may,  besides,  produce  the  not 
directly  intended  abortion.  One  is  allowed  to  employ  means 
which  are,  in  themselves,  good  or  indifferent,  in  order 
to  attain  a  good  effect,  although  they  may  be  supposed  to 
procure  at  the  same  time  a  forbidden  effect  not  intended, 
under  these  conditions  : — 

The  intended  good  effect  must  be  of  the  same  value  as 
the  damage  caused  by  that  forbidden. 

refusal,  lest  the  person  might  go  to  another  less  scrupulous  adviiser.  They 
recommend,  rather,  a  feigned  acceding  to  the  proposal,  by  prescribing  some 
indifferent  medicine  in  order  to  detain  the  person.  This  artiHce  will,  in  most 
cases,  fail.  But,  were  it  not  so,  even  such  feigned  acceding  to  so  criminal  a 
propoBal  seems  to  me  to  be  morally  wrong,  and  certainly  most  unworthy. 


ABORTION.  15 

The  means  employed  must  be  fit  to  procure  directly  and 
immediately  the  good  effect,  this  latter  not  resulting  from 
the  contemporary  forbidden  one. 

Any  other  means  to  attain  the  good  efi*ect  must  not  exist, 
or  be  unknown. 

Lastly,  every  precaution  must  be  taken  to  avoid  the 
forbidden  effect. 

Thus  it  is  allowable  for  a  physician  (cfr.  Gury,  1.  c,  tract, 
de  V.  402)  who  treats  a  sick  pregnant  woman,  even  when 
there  is  no  imminent  risk  of  life,  to  use  remedies  which, 
according  to  the  experience  of  medical  science,  are  directly 
necessary  or  useful  to  cure  the  mother,  even  although 
sueh  remedies  may  cause  abortion.  They  should  not, 
however,  do  so  necessarily,  but,  in  reality,  very  seldom. 
A  possible  danger  to  the  foetus  is  counterbalanced  by  the 
probable  or  sure  cure  effected  by  the  remedies.  Thus  the 
directly  intended  good  effect  is  of  equal  value  with  the 
perhaps  ensuing  bad  one.  To  this  category  belong  all 
pharmaceutical  preparations  for  internal  use  in  such  doses 
as  are  requisite  to  cure  other  diseases  ;  also,  baths,  blood- 
letting, injections  into  the  genital  organs,  and  the  like. 
Of  course,  in  using  these,  or  such  like  external  or  internal 
remedies,  we  must  not  go  beyond  what  is  necessary  to 
save  the  mother.  The  physician  is  bound,  in  using  such 
remedies  as  those  above  alluded  to,  to  hinder,  as  much  as 
may  be,  the  possible  effect  of  abortion.  Furthermore, 
a  direct  and  immediate  danger  to  the  mother's  life  existing, 
it  is  allowable  to  use  means  which,  while  apt  to  save  the 
mother  directly  and  immediately,  may  yet,  probably,  at 
the  same  time,  cause  abortion,  if  there  be  no  other  means 
of  saving  the  mother,  and  all  care  be  taken  to  avoid  the 
abortion.  I  have  proved,  in  my  dissertation  above  quoted, 
(pag.  73  ff.)  that  in  all  cases,  with  the  exception  of  one, 


16  THE   FIFTH   COMMANDMENT. 

where  accoucheurs  nowadays  believe  an  artificial  abortion 
indicated,  the  one  or  the  other  of  these  conditions  is 
wanting.  Especially  this  condition,  that  the  saving  of  the 
mother  is  to  result  immediately  from  the  remedy  employed, 
is  never  found  in  the  premises.  In  all  such  cases,  then, 
the  saving  of  the  mother  would  result  only  from  the 
removal  of  the  foetus,  from  the  interruption  of  pregnancy  ; 
wherefore  an  indirect  inducement  of  abortion  cannot  be 
allowed.  Abortion  itself  would  be  the  means  of  saving  the 
mother,  and  it  is  not  allowed  to  employ  it  directly  as  such. 
This,  and  all  the  other  conditions,  are  found,  I  think, 
only  in  the  single  case  where  the  uterus,  with  the  foetus,  is 
locked  in  the  upper  strait,  as  may  happen  through  retro- 
version, sinking  and  prolapsus  of  the  pregnant  womb.  If 
all  other  known  means  of  turning  or  replacing  the  uterus 
fail,  I  believe  it  to  be  allowable  *  to  induce  abortion  in- 
directly, by  procuring  the  discharge  of  the  waters,  or  by 
the  perforation  of  the  foetal  membranes  ;  for : 

1.  The  mother's  life  is  in  an  immediate  danger  and 
will  perish  with  the  foetus,  unless  the  womb  is  replaced. 

2.  There  is  no  other  means  of  saving  the  mother. 

3.  To  let  the  bag  of  waters  escape  has  an  immediate 
tendency  to  avert  danger  to  the  life  of  the  mother.  In  this 
case,  the  danger  to  the  mother  is  not  caused  by  pregnancy, 
physiologically  speaking,  but  simply  by  the  mechanical 
enlargement  of  the  womb.  The  discharge  of  the  water 
removes  this  mechanical  obstacle,  contracts  the  womb,  and 
this  contraction  has,  for  its  immediate  result,  the  possibility 
of  replacing  the  womb,  and  thus  averting  the  danger  to 

•  I  have  learned  that  some  theologians  do  not  approve  of  hi  direct  abortion 
even  in  this  case.  I  see  no  reason  to  recede  from  my  opinion,  until  my 
reasonings  are  refuted  and  until  I  am  convinced  that  there  is  wanting  ono 
of  the  conditions  which  would  make,  according  to  the  above,  the  operation 
allowable. 


PERFORATION   OF   THE    LIVING   FCETUS.  17 

the  mother,  before  the  abortion,  that  is  certain  to  follow, 
may  ensue,  and  without  making  abortion, — that  is,  expul- 
sion of  the  foetus  from  the  womb, — necessary. 

Fortunately,  it  is  of  rare  occurrence  that  the  womb  is 
locked  in  this  manner;  and  the  impossibility  of  replacing 
it  so  seldom  occurs,  that  Martin,*  among  fifty-seven  cases, 
only  once  had  to  perforate  the  foetal  membranes.  In  fifty 
of  these  fifty-seven  cases  the  uterus  was  replaced,  spon- 
taneous abortion  ensued  five  times,  followed  of  course  by 
replacing  of  the  womb  ;  one  woman  was  put  into  the  hos- 
pital, in  a  dying  condition,  in  consequence  of  vain  attempts 
to  empty  the  bladder :  this  one  died,  the  uterus  not  having 
been  replaced.  The  female  operated  on  by  perforation  of 
the  membranes  died  also. 

2.— PERFORATION  OF  THE  LIVING  FGETUS. 

The  operations  of  lessening  the  size  of  the  child  in  order 
to  accomplish  delivery  (perforation,  cephalotripsia,  embryo- 
tomy, embryothlasy)  were  partly  known  to  the  ancients. 
But,  until  the  beginning  of  this  century,  proof  of  the 
child's  death  was  considered  as  a  condition,  sine  qua  noHj 
of  performing  them.  But,  later  on,  the  custom  of  perform- 
ing them  grew  more  and  more  common  ;  and  it  is  nowadays 
regarded  as  indicated,  when  the  alternative  lies  between 
the  Csesarean  operation  and  perforation,  in  order  to  bring 
about  the  delivery,  and  the  mother  is  unwilling  to  consent 
to  the  former. 

Is  perforation  of  the  living  fcetus  allowed  as  a  means 
of  saving  the  mother  ?  Certainly  not,  because  it  is  a  direct 
killing  of  the  foetus,  which  is  always  forbidden. 

■^  Martin,  Die  Neigungen  und  Beugungen  der  Gebdr mutter  ;  Berlin,  1866  ; 
und  Zeitsckrift  fuer  Geburtshilfe  und  Frauenkrankheiten  von  Martin  und 
Fassbender.    1874,  I.  1. 


18  THE   FIFTH    COMMANDMENT. 

Moreover,  in  most  cases  it  is  not  the  only  means,  because 
the  Csesarean  operation  can  ahnost  always  be  resorted  to. 

Lastly,  it  is  not  a  sure  means  of  saving  the  mother, 
although  certain  death  to  the  child. 

People  have  accustomed  themselves  to  look  upon  the 
Csesarean  operation  as  nearly  always  fataL  Some  moralists 
therefore  are  inclined  to  think  it  a  means  not  well  suited 
to  avert  danger  from  mother  and  child.  Formerly  the 
Csesarean  operation  may  have  very  often  proved  fatal^  but 
nowadays  it  is  comparatively  safe. 

Statistics*  show  that,  of  100  mothers  on  whom  this 
operation  was  performed,  38  were  saved  according  to 
Kayser,  46  according  to  Michaelis,  57  according  to  Her- 
mann, according  to  Indes-Lacomb  60,  and,  according  to 
Villeneuve,  69.  As  an  average,  54  mothers  were  saved 
out  of  100. 

These  statistics  establish  the  fact  that  the  death-rate 
ensuing  from  the  Cesarean  operation  is  certainly  decreasing, 
owing  to  improved  surgery  and  treatment.  This  is  made 
very  clear  from  a  table  arranged  by  Gariraond.t  According 
to  this,  of  100  mothers  operated  on  by  Csesarean  section : 

32  were  saved  1750-1800. 
37  "  "  1801-1832. 
51  "  "  1832-1839. 
60     "         "      1839-1861. 

Garimond  followed  the  tables  of  Keyser,  Lauth,  Gueniot 
and  Joulain.  Besides,  if  we  consider  that,  through  this 
operation,  65  (Scanzoni),  67  (Michaelis  and  Hermann),  70 
(Kayser),  even  72  (Villeneuve)  per  cent  of  children  have 
been  saved,  not  only  can  we  not  call  the  Caisarean  operation 

*  Compare  Capellmaiin,  dc  occisione  foetus,  page  36. 

t  Traite  tkeorique  et  practtque  de  Vavortement,  consider^  au  point  de  vue 
mddicat  chirurgical  et  medico-le'/al,  par  hviile  Garimond.  Paris,  1873: 
Adrien  Delahaye  (quoted  afier  Schmidt's  Jahrbuecher,  1874.  Bd'.  16J,  No.  3). 


PERFORATION   OF   THE    LIVING    FCETUS.  19 

with  any  truth  a  "  vSritahle  operation  de  sauvage  (Ferdut*), 
especially  when  we  take  into  consideration  the  gravity  of 
the  circumstances  which  demand  its  performance,  but  we 
must  praise  it  as  a  most  benign  operation,  and  as  a  bene- 
ficent means  of  sparing  human  life. 

The  operations  of  perforation,  etc.,  praised  so  much  by 
comparison  with  the  Csesarean  operation,  result  far  other- 
wise from  what  we  should  have  expected  after  so  many 
laudations.  The  table  of  R.  Lee  (quoted  after  Kilian), 
although  relatively  the  most  favorable,  shows  that,  of  127 
mothers  operated  on  in  this  way,  23  died  ;  according  to 
Professor  Halbertsma.f  of  100,  39-39.5  died  j  and  of  course 
all  the  children  perished. 

At  an  average,  according  to  the  above,  of  200  lives, 
122.5-123.0  are  saved  under  the  Csesarean  operation, 
72.5  under  perforation,  etc.  Surplus  in  favor  of  Csesarean 
operations,  50  lives. 

These  calculations  cannot  claim  absolute  accuracy. 
Nevertheless,  they  render  it  sufficiently  clear  that  the 
Csesarean  operation  saves  a  great  many  children,  and  is 
not  so  fatal  to  the  mother  as  perforation,  etc. ;  that,  on 
the  other  hand,  the  operations  of  perforation,  etc.,  while  cer- 
tainly fatal  to  the  child,  afford  but  very  slender  chances 
of  saving  the  mother,  and  are  nearly  as  great  a  risk  to 
her  as  the  Csesarean  operation  itself.  This  should  suffice  to 
make  us  reject  any  such  operations,  even  from  a  simply 
utilitarian  standpoint. 

But  even  let  us  take  the  case  wherein  all  accoucheurs 
would  regard  perforation  as  indicated :  for  instance,  let  it 
be  an  alternative  between  perforation  and  the  Ca^sarean 

*  Ferdut,  E.,  de  Vavortevient  au  point  de  vue  medical,  etc.  Paris,  1865: 
page  1U3. 

t  T.  Halbertsma,  Prof,  in  Utrecht.  (Cfr.  Schmidt's  Jahrbiiecher,  1874,  Bd. 
161,  No.  3,  pag.  269.) 


20  THE   FIFTH   COMMANDMENT. 

operation,  between  the  necessity  to  terminate  delivery  in 
order  to  save  the  mother,  and  the  mother's  unwillingness 
to  have  the  latter  operation  performed, — even  in  this 
case  it  can  never  be  lawful  for  the  physician  to  kill  the 
child.  There  is  absolutely  no  other  way  open  to  him  than 
to  await  the  death  of  mother  or  child, — either  of  whose 
deaths  he  cannot  avert  by  lawful  means, — and  then  to 
render  to  the  surviving  one  every  assistance  his  art  may 
have  taught  him. 


II. — OPERATIONS   ATTENDED   WITH   RISK   TO   LIFE. 

These  are  performed,  in  order  to  avert  either  a  mediate 
or  immediate  danger  to  life  ;  sometimes  to  correct  deformi- 
ties that  either  disfigure  or  discommode  the  body. 

To  perform  such  operations  in  order  to  avert  danger  to 
life  is  allowed,  because,  instead  of  probable  death,  the 
saving  of  life  is  rendered  probable,  or,  at  least,  possible. 
They  are  allowed,  should  there  be  even  mediate  or  remote 
danger  to  life.  For  the  danger  may  increase  by  waiting 
longer,  whilst  the  strength  of  the  constitution  to  bear  up 
against  the  operation  and  its  consequences  may  be  gradually 
impaired,  and  so  the  success  of  the  operation  endangered. 

Dangerous  operations,  performed  in  order  to  correct 
evils  that  only  disfigure  or  discommode,  must  be  regarded 
in  a  different  light.  They  cannot  at  once  be  pronounced 
allowable.  We  have  to  make  a  distinction  :  Is  it  allowable 
for  a  patient  to  desire  an  operation  of  the  kind,  and  is  the 
physician,  when  urged,  allowed  to  perform  it?  To  the 
latter  question,  I  would  answer  in  the  affirmative.  If  the 
patient  is  sufficiently  aware  of  the  risk  incurred  in  the 
operation,  and  still  persists  in  urging  it,  the  physician  may 


OPERATIONS   ATTENDED   WITH   RISK   TO    LIFE.  21 

perform  it.  But  whether  the  patient  is  allowed  to  demand 
an  operation  with  risk  to  life  for  the  end  aforesaid,  pro- 
vided he  has  reasonable  grounds  to  hope  for  a  successful 
issue,  in  general  I  do  not  take  on  myself  to  decide.  Bodily- 
deformities,  either  very  disfiguring,  or  causing  grave  in- 
convenience, may  under  certain  circumstances  affect  this 
or  that  individual  so  seriously,  and  may  become  so  insuffer- 
able, that  the  patient  would  have  a  right  of  choice  whether 
to  hazard  his  life  thus  embittered,  in  the  hope,  in  case  of 
success,  of  enjoying  a  life  free  from  the  deformity  under 
which  he  had  been  laboring,  or  of  surrendering  his  insuffer- 
able life,  should  the  operation  result  unfavorably.  I  have 
not  been  able  to  find  a  decision  of  this  question  ex  analogia 
in  the  moralists.  In  illustration,  I  will  give  here  the 
following : — Suppose  a  man  confined  to  unjust  and  hard 
captivity,  with  no  other  avenue  to  freedom  open  to  him 
than  one  involving  risk  to  life, — would  he  not  be  allowed  to 
run  this  risk,  in  order  to  enjoy,  if  successful,  his  freedom, 
and,  if  not,  rather  to  surrender  a  life  made  unendurable  to 
him  %  In  my  opinion  he  is  allowed  to  do  so,  provided 
there  be  a  reasonable  hope  of  success. 

In  each  single  instance,  therefore,  the  peculiar  individual 
case  of  the  patient  in  question,  the  inconveniences  occurring 
from  his  state  of  health,  and  the  prospect  of  success,  should 
be  weighed,  and  decision  be  given  accordingly.  Happily 
such  cases  are  very  rare. 

Whether  one  is  bound  to  have  an  operation  performed 
which  endangers  life,  be  it  in  order  to  avert  an  imminent 
risk  of  life,  or  be  it  only  to  remove  an  evil  which  is  a 
deformity  and  is  a  source  of  annoyance  to  others,  is  quite 
another  question.  In  the  latter  case,  certainly  not.  -  Even 
in  order  to  save  imperilled  life,  the  best  moralists  decide 
that   no   one   is    obhged  to    undergo   a  severe   operation 


2-2 


THE  FIFTH   COMMANDMENT. 


involving  risk  of  life,  althougli  affording,  at  the  same  time, 
a  hope  of  its  preservation.  "  Non  teneris  vitae  servandae 
causa  pati  amimtationem  cruris  sive  hrachii,  aid  incisionem 
ventris  ad  extrahendum  calcidumy  (Liguori.*)  But  in  my 
opinion  this  decision  does  not  consist  with  the  present  devel- 
opment of  medical  science  and  surgery,  difficult  operations 
being  now  performed  under  greatly  changed  circumstances, 
and  with  better  success.  '^ Non  tenetur  quisj^  says  Gury 
(1.  c),  '^servare  vitam  remediis  extraor  dinar  lis,  quaeque  maxi- 
mum dolorem  offer  ant  ^  non  datiir  enim  ohligatio  servandae 
vifae,  nisi  mediis  ordinariiSj  quae  magna  non  adducunt 
incommoda  .  .  .  ncque  dolor es  valde  acerhos  caiisant.^^  ^^  Cum 
servare  vitam  operatione  dolores  nimis  atroccs  afferente  extra 
communes  vires  posifum  sit.''^  (Scavini.f)  The  sufferings  of 
the  patient,  and  the  difficulty  of  operations,  are  here  the 
prominent  conditions  on  which  the  decisions  rest.  But 
how  is  it  now,  when  chloroform  renders  patients  almost 
unconscious  of  pain  throughout  severe  surgical  operations  ? 
Does  the  determination  to  attempt  to  escape  certain  death, 
with  a  probability  of  life  by  a  painless  operation,  overtax 
the  ordinary  powers  of  man  ?  The  use  of  chloroform  as  an 
agent  for  the  relief  of  pain  during  surgical  operations  is  now 
well  known,  even  to  those  outside  of  the  profession ;  and 
this  fact  has  done  a  great  deal  to  lessen  the  fear  of  the 
surgeon's  knife.  This  has  to  be  well  weighed  in  the  solution 
of  our  question.  Of  course,  the  wound  caused  by  the 
operation  will  give  pain  afterward  j  but  such  pain  will  not 
be  greater  than,  and  generally  not  so  great  as,  that  caused 
by  the  disease  which  necessitated  the  operation.  Besides 
the  pain,  consideration  is  due  to  the  fact  that,  sometimes,  a 
permanent  disfigurement  is  the  consequence  of  an  operation 

*  Cfr.  Gurj,  tract,  de  v,  praeo.  391.  3. 

t  Scaviui^  a*act.  vii,  disp.  ii,  oap.  1,  art.  i,  $  2,  qu.  3. 


THE    CvESAREAN   OPERATION.  23 

by  which  life  has  been  saved — by  the  loss  of  a  limb,  for 
example.  But,  even  in  this  case,  the  remarkable  mechanical 
contrivances  of  our  days  afford  much  relief.  Artificial 
teeth,  limbs,  etc.,  almost,  and  sometimes  altogether,  remove 
the  disfigurement^  and  even  supply  the  missing  activity. 
The  decision,  therefore,  given  hitherto  by  moralists  must 
be  modified.  I  do  not  take  it  on  myself  to  make  that 
decision. 

In  regard  to  one  operation,  the  Csesarean,  I  am  able  to 
speak  in  a  more  positive  manner.  In  cases  wherein  the 
natural  delivery  is.only  possible  after  perforation,  or 
wherein,  even  then,  the  child  cannot  be  delivered  per  vias 
naturaleSj  the  Csesarean  operation  is  indicated  according 
to  the  laws  of  both  science  and  morals.  In  the  former 
case,  if  the  operation  be  not  performed,  the  child  may  be 
delivered  after  its  death ;  but  even  then  only  by  a  painful 
operation,  and  one  always  hazardous  to  the  mother.  In 
the  latter  case,  both  mother  and  child  must  inevitably  die 
unless  the  Csesarean  operation  be  performed.  The  mother, 
therefore,  in  considering  the  question  whether  she  will 
consent  to  have  the  operation  performed,  must  not  only 
take  thought  for  her  own  welfare,  but  for  that  of  her 
child  as  well,  which  would  inevitably  die  without  this 
operation.  We  have  stated,  above,  that  it  is  not  allowed 
to  sacrifice  the  life  of  the  child  in  order  to  save  that  of 
the  mother:  here  we  ask,  Is  the  mother  allowed  to  leave 
her  child  to  die  when,  by  the  Csesarean  operation,  a  chance 
is  afforded  of  saving  it  f 

If  the  child  could,  after  its  death,  be  delivered  in  the 
natural  way,  the  mother  would  have  to  run  the  risk  of 
a  lessening  operation,  should  the  Csesarean  operation  not 
be  performed.  The  dangers  of  the  former  are  not  much 
less  than  those  of  the  operation,  especially  since  the  strength 


24  THE   FIFTH   COMMANDMENT. 

of  the  motlier  is  impaired  during  the  period  of  waiting  for 
the  child's  death.  Consequently,  the  former  would  have 
to  be  performed  under  unfavorable  circumstances.  The 
dread  of  the  operation,  on  which  the  moralists  (cfr.  Gury- 
Ballerini,  pag.  385,  note  vi)  lay  particular  stress,  may  be 
done  away  with  by  the  application  of  chloroform.  The 
peritia  medici  asked  for  is  just  as  much  required  to  per- 
form perforation  as  the  Csesarean  operation,  and  cannot 
therefore  be  of  great  weight  in  deciding  which  operation 
should  be  selected.  If  the  physical  strength  of  mother 
and  child  give  a  reasonable  hope  to  save  the  life  of  both, 
I  hold  the  mother  bound  to  undergo  the  latter. 

"What  has  been  said  here  applies  with  still  greater  force 
to  the  case  wherein  the  child,  even  after  the  lessening, 
cannot  be  delivered  per  vias  natufales^  and  both  mother 
and  child,  could  no  remedy  be  found,  would  inevitably  have 
to  die.  As  a  chance  of  saving  the  life  of  both  is  offered 
by  the  Csesarean  operation,  the  mother  is  certainly  bound 
to  undergo  it.  This  operation,  of  course,  is,  as  the  moralists 
have  it,  ''remcdium  extraordinarium  ad  servandam  vitam  ;" 
but  it  is  not  so  much  to  be  dreaded  as  non-professionals 
imagine  it  to  be,  especially  when  the  patient  is  placed 
under  the  influence  of  an  anaesthetic.  Sometimes,  even 
now,  this  operation  is  performed  without  an  anaesthetic. 
I  had  several  times  occasion  to  observe  that  an  average 
amount  of  moral  courage  does  enable  the  patient  to  endure 
its  pain  even  without  chloroform.  The  dread  is  worse  than 
the  operation  itself,  because,  in  the  eyes  of  men  outside 
of  the  profession,  an  incisio  ventris  is  a  most  terrible  thing. 
Perforation,  etc.,  and  the  subsequent  extraction,  are,  as  far 
as  came  under  my  observation,  more  painful  than  the 
Csesarean  operation;  but  they  are  not  feared  so  much,  be- 
cause the  extraction  can  be  accomplished^cr  vias  naturaleSj 


OPERATIONS   ATTENDED   WITH    RISK   TO    LIFE.  2o 

and  the  wounds  and  lesions  are  made  directly  on  the  child's, 
and  not  on  the  mother's,  body. 

The  questions,  what  other  obstetric  operations  are  lawful, 
and  when  they  are  binding,  are  easily  answered,  if  the 
supposed  operations  are  conducted  in  a  proper  manner. 
Such  operations    as  are  required   in  cases  of   dangerous 
labor, — the  use  of  the  forceps,  turning  the  child,  induc- 
tion of  premature  labor, — when  used  according  to  the  rules 
of  medical  art,  in  the  proper  time  and  manner,  only  tend 
to  expedite  delivery,  and  thus  to  save  mother  mid  child. 
To  induce  premature  labor, — namely,    to  induce  delivery 
at  a  period  of  incomplete  pregnancy,  but  when  the  foetus 
has  attained  sufficient  development  to  be  capable  of  living 
separate  from  the  mother, — is  the  most  likely  of  all  these 
operations    to  put  the    child's  life  in   jeopardy,   since  its 
organs  are  as  yet  not  perfectly  developed,  and  therefore 
not    fully  capable  of   sustaining  external   influences    and 
the  changed  mode  of  nutrition.     Tliis  operation  may  be 
required,  first,  in  cases  wherein  the  delivery,  at  the  full 
period  of  pregnancy,  can  only  be  accomplished  either  by 
a  difficult  operation,  hazardous  to  both  mother  and  child — 
even  by  perforation  itself;  and  wherein  there  is  a  reason- 
able hope  of  having  the  child    delivered,  at    an    earlier 
than    the    natural    period,   livingj  and    capable  of  living, 
without  particular  danger  to  the  mother.     In  this  case  the 
mother  cannot   be  bound    to  await  the  natural    term  of 
parturition,   thereby   hazarding  her  life.     It  is  therefore 
allowable  to  induce  premature  labor  by  artificial  means, 
and  the  mother  may  even  be  bound  to  select  such  means, 
especially  as  there  will  be  no  intense  pain,  nor  insurmount- 
able fear. 

The  same  applies,   probably  with  still  greater  force,  to 
the  second  class  of  indications  to  induce  premature  labor : 


26  THE    FIFTH    COMMANDMENT. 

dangerous  diseases  of,  and  accidents  to,  the  mother  during 
pregnancy,  when  the  mother  might,  and  probably  would, 
be  saved  by  this  operation.  If  the  mother  should  die 
before  delivery,  the  child  would  also  be  in  extreme  peril. 
The  induction  of  premature  labor  would  therefore  be  in 
this  case  beneficial  to  both  mother  and  child. 

Finally,  mention  may  here  be  made  of  the  Csesarean 
operation  performed  after  death.  Should  a  woman  die  after 
the  twenty-eighth  week  of  her  pregnancy,  the  Csesarean 
operation  is  commanded  by  law,  the  latter  not  regarding 
whether  the  foetus  be  alive  or  not.  Whether  it  is  the 
right  policy  to  limit  the  time  of  this  legal  obligation  to  the 
completion  of  the  twenty-eighth  week  of  pregnancy,  is,  at 
least,  doubtful,  especially  if  we  consider  the  possibility  of 
the  child's  baptism.  Of  course,  during  the  first  months  of 
pregnancy,  there  is  no  hope  of  extracting  the  foetus  living, 
by  means  of  the  Csesarean  operation.  But  I  would  always 
perform  this  operation  after  the  completion  of  the  fourth 
month,  in  order  that  the  child  might  receive  baptism  ;  so 
often,  at  least,  as  no  very  grave  reason  led  me  to  believe 
that  the  child  died  before  the  mother,  or  with  her  ;  especially 
after  a  sudden  or  quick  death  of  a  pregnant  woman. 

Of  course,  this  operation  should  be  performed  as  soon 
as  possible  after  the  death  of  the  mother.  There  may 
be,  at  times,  no  little  difficulty  in  this,  as  it  is  not  always 
easy  to  ascertain  conclusive  signs  of  death,  especially 
after  sudden  and  quick  deaths.  But  to  ascertain  these 
signs  belongs  to  the  province  of  the  physician,  who  may 
show  in  these  very  cases  what  promptness  and  decsion 
can  do.  He  will,  as  far  as  possible,  perform  the  operation 
with  as  much  caution  as  if  he  were  performing  it  on  a 
living  woman.  Thus  nothing  would  be  lost,  even  in  a  case 
of  catalepsy  not  previously  ascertained.     But  what  shall 


OPERATIONS   ATTENDED    WITH    RISK    TO    LIFE.  Z/ 

be  done  in  the  event  of  a  physician  not  being  at  hand  ? 
Should  not  the  priest,  who,  in  cases  of  serious  illness,  is 
almost  invariably  summoned,  perform  the  operation  ?  It 
has  been  done  sometimes  by  energetic,  zealous  priests,  but 
indiscreetly,  in  my  opinion.  I  cannot  agree  with  the  worthy 
Vering,*  who  believes  it  necessary  for  every  priest  to  know 
how  to  perform  this  operation,  and  even  imposes  it  as  a 
duty  upon  them  rather  to  perform  it  themselves,  in  cases 
of  extreme  necessity,  than  to  suffer  the  child  to  die  without 
baptism.  Neither  the  exclamations  of  Debreyne,  t  nor  the 
strong  language  of  Macher,  |  who  calls  those  ^'imbeciles" 
who  hold  it  to  be  indecorous  for  a  priest  to  perform  the 
Csesarean  operation,  can  convert  me  to  this  opinion.  In- 
decorous it  is :  that  needs  no  explanation.  With  the  same 
right,  priests  should  go  through  a  course  of  midwifery,  to 
perform,  in  cases  of  necessity,  the  duties  of  accoucheurs. 
In  rural  districts,  children,  even  sometimes  both  mothers 
and  children,  might  thus  be  saved.  For  a  priest,  it  would 
not  be  more  indecorous  to  save  both  mother  and  child  in 
case  of  Si  placenta  praevia  (which  places  mother  and  child 
in  extreme  peril),  by  speedy  termination  of  delivery,  than 
to  save,  probably,  the  child  by  the  Csesarean  operation. 
The  only  difference  would  be  this,  that,  in  the  first  case, 
everybody  would  think  it  absurd  to  impose  such  a  duty 
upon  a  priest,  whilst,  in  the  second,  one  writer  asserts  after 
the  other  :  '^  It  shall  be  so — because  it  has  been  so,  and  thus 
appears  to  be  possible."  Such  an  aberration  is  easily 
explained.  To  persons  outside  of  the  profession  it  is  an 
heroic  deed  to  perform  this  operation,  and  the  indecorous 
is  easily  overlooked  on  account   of  the   heroic.     But   to 

*  L.  c,  pag.  257.  Veiiiig  and  others  follow  tlie  doctrine  of  Cangliuniilla, 
who  treats  at  large  this  obligation  of  the  priest  to  perform  the  Caesareau 
operation,  post  mortem.  {Embryolor/ia  Sacra,  lib.  ii,  cap  xiv.) 

t  L.  c,  pag.  247.  t  L.  c,  pag.  338. 


28  TITE    FIFTH    COMMANDMENT. 

perform  this  operation  is  not  only  indecorous,  but  even 
dangerous,  on  the  part  of  non-professionals.  Apart  from 
the  difficulty  of  proving  death  certain,  the  operation  re- 
quires a  detailed  knowledge  of  the  parts  and  great  technical 
ability,  which  non-professionals  cannot  have,  even  should 
they  know  by  heart  an  exact  description  of  the  operation. 
To  perform  the  Csesarean  operation  on  the  warm,  new 
corpse  is  exciting  even  to  professionals ;  especially  as  there 
is  generally  no  assistance  from  a  brother-physician,  and  no 
time  to  be  lost  in  procuring  such.  The  alarm  caused  by 
the  occurrence,  the  anxious  apprehension  lest  the  supposed 
corpse  should  move,  the  copious  gushing  of  the  warm 
blood, — all  these  circumstances  allow  only  professionals  to 
maintain  a  mental  equilibrium,  because  they  are  well  in- 
formed, and  accustomed  to  bloody  operations.  Now,  will 
you  bind  the  priest  to  such  an  operation,  of  which  he  can 
liave  only  an  imperfect  knowledge  I  Would  he  not,  with 
the  little  knowledge  he  possesses,  be  almost  paralyzed  by 
his  well-grounded  fears,  and  thus  hazard  the  success  ?  I 
will  not  point  out  other  inconveniences.  Who  shall  secure 
the  priest  against  ill-speaking  ? 

There  exists  no  prohibition  by  the  Church  against  a  priest 
performing  the  incisio,  provided  there  is  no  doubt  as  to  its 
necessity.  I,  for  my  part,  concede  that,  in  such  a  case,  a 
priest  who  feels  himself  able  is  not  prohibited  from  performing 
the  operation.  But  there  can  be  no  obligation^  for  1  am 
not  bound  to  preserve  my  own  lifejper  media  extraordinaria  ; 
and  1  am  certainly  much  less  bound  to  preserve  the  life  of 
others  by  means  too  exacting  for  me  ^'  cum  id  extra  vires 
communes  positum  sit,^^ 


ON   THE    USE   OF   MEDICINES.  29 


III. — ON  THE   USE   OF   MEDICINES. 

When  the  health  is  seriously  impaired,  and  not  to  be 
restored  by  simple  means,  a  physician  should  be  consulted, 
if  possible  ;  and  the  patient  must  follow  the  directions  of 
his  physician,  unless  the  remedies  prescribed  bring  on 
molestiam  extraordlnariam*  The  Holy  Scripture  says : 
'^Honora  medi cum  propter  neccssitatem^  etenlm  ilium  crcavit 
Aliissimiis.  AUissiimts  crcavit  de  terra  inedicamentaj  et  vir 
prudens  non  dbhorrehit  illay  t 

The  patient  is  placed,  to  a  great  extent,  in  the  power 
of  the  physician,  because  he  has  no  knowledge  of  the  means 
prescribed,  but  he  must  use  them  in  good  faith.  The 
Most  High  created  medicines  for  this  end  only,  that  they 
should  be  used  for  the  welfare  of  body  and  soul.  Hence  it 
follows  that  the  physician  is  restrained  in  the  application  of 
remedies  : — 

1.  The  physician  should  always  make  use  of  such 
remedies  as  are  regarded  safe  in  the  existing  state  of 
medical  science.  If  no  specifics  be  known,  he  should  use 
that  remedy  which  will  probably  be  the  most  efficacious. 

2.  The  physician  should  not  experiment  upon  the 
human  body,  using  remedies  the  effect  of  which  he  does 
not  know,  i.  e.,  whether  they  are  beneficial  or  hurtful.J 

*  Scavini,  1.  c,  tract,  iii,  disp.  ii,  cap.  i,  art.  iii,  qu.  5. 

t  Ecclus.  xxxviii. 

X  Experiments,  for  instance,  have  been  made  by  inoculating  secretions 
of  syphilitic  ulcers  for  different  purposes,  e.  g  ,io  make  a  diagnosis.  In  the 
doubt  whether  an  individual  is  syphilitic  or  not,  he  is  inoculated  with  fresh 
chancre-secretion  :  if  syphilitic,  the  inoculation  will  have  no  effect;  if  not 
syphilitic,  then  syphilitic  ulcer  will  be  formed  in  the  spot  of  inoculation. 
In  the  former  case,  the  individual  will  probably  not  be  hurt  by  this  experi- 
ment; in  the  latter,  the  damage  will  be  considerable,  as  the' individual  ia 
then  infected  with  syphilis  by  the  inoculation.  Therefore,  inoculation  with 
secretions  of  syphilitic  affections  (ulcers,  etc.)  cannot  be  admitted  as  a  means 
of  diagnosis. 


30  THE   FIFTH    COMMANDMENT.  ~" 

He  may,  of  course,  try  remedies  Avliich  he  knows  for  cer- 
tain will  be  harmless,  without  knowing  for  certain  whether 
they  will  prove  beneficial  in  the  case  in  question. 

To  a  patient  whose  case  is  hopeless,  the  physician  may 
administer  remedies  without  knowing  whether  they  will 
prove  beneficial  or  injurious  '^  ad  infirmi  salutem  curnn- 
damJ^  (But  they  cannot,  even  in  this  case,  be  given  ad 
experimentiim  faciendum  pro  aliis  wfirmis^  estenim  iUicitum 
quaerere  experimentum  in  alterkis  vita.)  ''Nam  conformins 
est  prudentiae  et  voluntati  ipsius  infirmi  applicare  illi  rcme- 
dlum  dabiumj  quam  illad  omittere  cum  certitudine  mortis,''* 

These  restrictions,  especially  the  one  prohibiting  ex- 
periments, bind  sub  gravi.  They  are  generally  respected  ; 
physicians,  as  a  rule,  being  careful  not  to  infringe  them.  But 
two  classes  of  remedies,  much  in  use  nowadays,  must  be 
treated  more  particularly,  namely,  «nof?^?2e5  and  ancesthetics. 

Pain  exists  in  nearly  all  diseases,  and  it  is  very  often 
one  of  the  first  signs  of  failing  health.  ''  In  this  regard,'* 
says  Albers,  t  "  pain  proves  a  very  beneficial  phenomenon, 
because  it  always  urges  the  removal  of  the  ofi*ensive  causes 
from  the  diseased  part.  Hence  Haller  calls  pain,  nature's 
remedy."  The  nature  of  the  pain  is  important,  inasmuch 
as  it  marks  the  way  to  a  proper  diagnosis  and  prognosis. 
Nevertheless,  pain,  next  to  death,  is  most  dreaded  by  the 
sick ;  and  to  be  relieved  of  it  is  their  supreme  anxiety. 
Hence,  medical  men,  in  all  ages,  have  sought  the  most 
effectual  means  of  assuaging  the  pains  of  the  sick.  In  our 
own  age,  medical,  perhaps  we  should  rather  say  chemical, 
science  has  accomplished  wonders  in  this  direction.  But 
are  there  no  restraints  to  be  put  upon  the  application  of 

*  Srarini.  1.  c.  ibid.,  qurest.  3,  R.  2. 

tAU)ei8^  Prof,  Dr.  I.  F.  H.,    Lehrhuch  dcr  Semiotil:.     Leipzig:  Kai-1 
CuobLch,  LStil.  page  UJ, 


ox   THE   USE    OF   MEDICINES.  31 

tliese  remedies,  and  are  not  these  restraints  too  often 
transgressed  ! 

To  assuage  pain  by  the  use  of  medicines  is  no  doubt 
allowed,  as  long  as  the  anodynes  employed  do  not  retard 
recovery,  or  do  not  directly  injure  or  endanger  health 
and  life.  For  the  relief  of  paia  is  not  of  so  much  import- 
ance as  the  restoration  or  preservation  of  health  itself.  I 
speak  here  purely  from  a  physician's  point  of  view,  and 
am  not  at  all  treating  of  pain  with  regard  to  its  place  in 
morals  and  ascetics. 

The  use  of  anodynes  becomes  detrimental,  if  they  are 
given  in  doses  so  large  as  to  be  hurtful  to  health,  or  if 
they  are  administered  so  often  that  the  organism  becomes 
accustomed  to  them,  and  the  nervous  system  thereby 
impaired. 

The  new  method  of  injecting  medicines  subcutaneously 
has  done  away  with  many  evils  attending  the  use  of 
narcotics  when  taken  into  the  stomach  ;  but  its  excessive 
simplicity  of  administration  has  led  to  a  deplorable  abuse 
in  its  employment.  An  anodyne  much  in  use  is  morphia, 
which  is  generally  administered  by  injection.  The  little 
pain  caused  by  the  needle,  and  the  sure  and  prompt  action 
of  the  drug  thus  applied,  have  made  many  a  physician  too 
fond  of  using  the  syringe  whenever  severe  pain  is  com- 
plained of.  This  would  not  be  very  objectionable,  but  for 
the  evil  consequences  attending  it.  In  the  anxiety  to 
remove  the  pain,  its  cause  is  often  not  attacked,  much  less 
removed.  As  soon,  therefore,  as  the  drug  ceases  to  have 
its  effect,  the  pain  returns,  often  in  an  aggravated  form, 
because  the  after-effects  of  morphia  on  the  nervous  system 
often  weaken  the  power  of  the  nerves  to  withstand  pain. 
The-n  the  patient  beseeches,  with  continually  increasing 
importunity,    to    have    the   injections    repeated.     If    not 


32  THE   FIFTH    COMMANDMENT. 

humored,  lie  is  only  the  more  intractable,  and  his  demands 
are  attended  witli  insults.  Finally,  the  physician  yields, 
and  the  play  is  soon  acted  over  again.  In  acute  diseases, 
wliich  do  not  last  very  long,  physicians  of  sufficient  firmness 
will  not  repeat  the  injection  too  often ;  and  then  any  harm 
done  will  be  soon  repaired.  Bat  how  to  act  in  chronic 
painful  diseases  ?  Whether  of  his  own  accord,  or  forced 
by  the  incessant  clamors  of  his  patient,  who  now  knows 
how  his  pain  may  be  relieved,  the  physician  makes 
the  lamentable  injection,  time  after  time ;  the  patient's 
power  of  resisting  becomes  rapidly  enfeebled,  and  the  in- 
jection repeated  becomes,  every  time  of  its  administration, 
more  and  more  of  a  necessity.  At  lengtli,  whether  for 
convenience'  sake,  or  to  escape  the  tiresome  importunities 
of  his  patient,  the  physician,  especially  in  incurable  chronic 
affections,  takes  the  fatal  step,  and  hands  over  the  syringe 
to  the  patient  himself  or  to  his  relatives,  and  then  the 
descent  is  rapid.  The  injection  is  administered  more  and 
more  frequently,  the  doses  are  gradually  increased,  the 
power  of  resistance  diminishes,  until,  finally,  the  terrible 
remedy  has  become  a  habit.  The  patient  is  now  pallid, 
now  apathetic,  now  excited  ;  disagreeable  feelings  of  beat 
and  cold  alternate  ;  he  trembles  like  a  drunkard  as  long  as 
no  morphia  is  administered  to  him.  Gradually  his  con- 
stitution gives  way  under  the  effects  of  sleeplessness,  loss 
of  appetite,  impaired  digestion.  An  attempt  to  deprive 
him  of  morphia  is  followed  by  chills,  general  pains,  severe 
diarrhoeas ;  by  uneasiness  and  anxiety,  accompanied  with 
unceasing  wakefulness,  leading  at  length  to  a  state  of  raving 
madness.  The  effort  to  deprive  the  patient  of  his  solace 
is  soon  abandoned,  and  the  terrible  '^ remedy''  is  again 
resorted  to.  Mental  debility,  approaching  complete  apathy, 
soon  takes  possession  of  him  j  illusions  and  hallucinations 


ON   THE   USE    OF   MEDICINES.  33 

gradually  increase,  and  the  ^^  treatment'"  ends,  often,  in  the 
insane  asylum. 

Can  this  be  tolerated  ?  Or  am  I  exaggerating  1  Who 
is  the  physician  who  has  not  met  with  such  unfortunate 
cases,  and  do  we  not  find  them  constantly  described  in  the 
medical  journals  of  the  day? 

The  maximum  dose  of  morphia  J9er  diem  is  0.12  graram, 
according  to  the  German  pharmacopoeia ;  and  this  dose 
is  intended  to  be  used  only  during  a  short  period.  But 
those  who  have  become  victims  of  the  opium-habit  soon 
take  0.2-0.5  ;  others  take  more  than  1.0  per  diem,  and  as 
much  as  3.0  gramms :  a  ratio  of  increase  which  may  be 
understood  by  non-professionals,  when  we  tell  them  it  is 
as  if  a  man,  who  can  drink  two  bottles  of  wine  without 
becoming  intoxicated,  should  accustom  himself  gradually  to 
be  able  to  drink  twenty  to  fifty  bottles.  This  is  not  permis- 
sible. Of  course  the  patient  himself  is  to  blame  somewhat, 
but  the  physician  more.  There  can  be  no  excuse  for  em- 
ploying remedies  so  hazardous,  in  a  manner  so  reckless  and 
unconscientious.  In  places  unfortunate  enough  to  harbor 
these  '^morphia-doctors" — sit  venia  verho  ! — the  injection 
is  almost  looked  upon  as  a  hygienic  necessity.  Instrument- 
makers  drive  a  thriving  trade  in  selling  syringes,  not  to 
physicians,  but  to  non-professionals  :  as  I  have  been  assured 
by  persons  worthy  of  all  trust.  Physicians  have  co 
absolutely  discretionary  a  power  in  their  prescription  of 
medicines,  that  they  cannot  be  reached  by  law.  I  know 
the  risk  I  run  of  incurring  the  displeasure  of  some  of  my 
fellow-physicians  when  I  assert  that  this  most  useful  remedy, 
the  beneficence  of  whose  effects  cannot  be  overestimated,  is 
too  often  used  in  a  manner  which  renders  it  rather  a  curse 
than  a  blessing.  It  is  for  this  reason  I  have  given  the 
subject  prominence  here,  in  the  hope  that  the  clergy  may 


34  THE    FIFTH    COMMANDxAIENT. 

veto  such  abuses  as  are  contrary  to  divine  law,  since  the 
civil  law  is  powerless  to  reach  them. 

I  cannot  refrain  from  making  a  few  observations,  here, 
on  the  cure  of  opium-eating.  Having  been  a  physician  for 
many  years  in  an  insane  asylum,  and  having  watched  such 
cases  in  my  private  practice,  I  am  led  to  assent  to  the  views 
of  Professor  Leidesdorf  *  of  Vienna.  I  believe  him  to  be 
quite  correct  in  stating  that  the  first  condition  toward 
effecting  the  cure  of  an  opium-eater  is  to  place  the  patient 
absolutely  under  the  power  of  the  physician.  Burkart,1 
too,  is  of  the  opinion  that  the  restraint  of  liberty,  in  a  closed 
establishment,  affords  hope  for  the  best  results,  aUhough 
he  has  made  some  cures  without  such  restrictions  (in  the 
water-cure  institute,  Marienberg,  near  Boppard),  but  then, 
only  by  gradually  diminishing  the  dose.  Incredible  is 
the  persistence  with  which  the  victims  plead  for  fresh  doses 
of  the  fatal  poison ;  the  bitter  complaints  and  threats  they 
give  utterance  to,  when  they  are  withheld  ;  the  ingenuity  of 
cunning  they  display  in  order  to  procure  them.  These 
circumstances,  together  with  the  serious  symptoms  which 
result  from  the  withdrawal  of  morphia,  impose  upon  nurses 
and  relatives,  who  yield  to  the  patient's  importunities  with- 
out the  doctor's  knowledge :  and  thus  a  cure  becomes 
impossible.  I  once  knew  a  physician  who  had  firmly 
resolved  to  be  cured  of  this  habit,  and,  for  this  purpose,  had 
placed  himself  under  the  care  and  treatment  of  a  brother- 
physician.  Yet,  so  irresistible  was  the  propensity,  that  he 
took  morphia  without  his  fellow-physician's  knowledge,  as 


*  Leidesdorf  uher  MorpJiiumsucht  in  der  Wiener  Med.  Zeitschrift,  1876, 

No.  ye. 

t  BiirTcart,  Dr.  R.,  Die  chronische  Morphiumvcrgifhing  in  Folge  suhcu- 
taner  Morphium  Injectionen  und  deren  Behandlunr/.  Mitthe'dangen  aus  der 
Wasserheilanstalt  Marienberg  hei  Boppard  a.  E.  Bouii;  bei  Cohen  und 
Sohn:  1877. 


ON    THE    USE    OF   MEDICINES.  35 

he  confessed  to  him  afterward.  A  similar  case  is  related 
by  Leidesdorf  of  a  young  physician,  who  had  become  an 
opium-eater  experimenti  causa^  and  had  come  to  Leidesdorf 's 
institute,  because  he  knew  he  could  not  be  cured  without 
restraint  of  his  liberty.  All  persons  addicted  to  opium- 
eating  should  be  placed,  or  should  place  themselves,  in  a 
well-governed  institute  which  has  thoroughly  trained  nurses. 
A  better  course,  however,  would  be  to  place  them  in  an 
insane  asylum,  because  restraint  is  there  allowed,  and  can 
easily  be  put  into  practice :  and  restraint  is,  in  such  cases, 
not  only  justifiable,  but  indispensable  f  for,  so  feeble  is  the 
will  of  patients  afflicted  with  the  malady,  that  they  must 
be  considered  to  a  certain  extent  irresponsible.  Moreover, 
not  unseldom,  the  unfortunate  sufferers  are  prevailed  upon 
to  enter  institutions  voluntarily,  and  to  consent  to  the  short 
season  of  necessary  restraint. 

Priests  can  render  great  service  in  such  cases  by  prevail- 
ing on  the  patient  to  place  himself  in  an  institution  of  the 
kind,  when  a  cure  at  home  has  been  attempted  in  vain.  It 
is  in  their  power  to  impress  upon  him  the  impossibility  of 
being  cured  at  home,  and  the  probability  of  a  speedy  cure 
under  judicious  management  in  such  an  institution.  The 
cure  of  persons  who  have  not  taken  too  great  doses  {not 
over  0.2-0.3  per  diem)  must  be  effected  by  the  immediate 
total  abandonment  of  morphia. 

When  the  patient  has  become  accustomed  to  the  largest 
doses  (1.0-3.0),  the  abandonment  must  be  effected  gradu- 
ually  but  rapidly.  In  the  latter  case,  the  quantity  should 
be  reduced  to  0.05-0.1  per  diem  ^  and  this  dose  should  be 
diminished  so  quickly,  that  the  abandonment  may  become 
a  total  one  at  the  end  of  the   second   week.^*      Serious 


*  Leidesdorf,  1.  c. 


36  THE   FIFTH   COMAIANDMENT. 

symptoms  are  subdued  by  other  calming  remedies :  sucb 
as,  baths,  bromide  of  potassium,  hydrochlorate.  The 
strength  is  sustained  with  nourishing  food  and  wine.  This 
treatment  will  effect  a  cure  according  to  Leidesdorf  in  two 
to  three  weeks,  and  will  seldom  be  protracted  longer  j  never, 
at  all  events,  above  eight  weeks. 

I  will  not  make  any  mention  here  of  certain  other  an- 
odynes which  are  less  employed,  and  are  less  active  and 
dangerous,  but  will  proceed  to  offer  a  few  suggestions 
on  the  application  of  anaesthetic  agents  j  of  which,  etlier 
and  chloroform  are  the  most  used. 

The  discovery  of  chloroform,  and  its  employment  as  a 
surgical  anaesthetic,  must  be  hailed  as  an  incalculable 
benefit  to  the  suffering  human  race.  Every  living  organ- 
ism has  a  horror  of  pain,  especially  of  the  pain  caused  by 
surgical  operations.  The  premonitory  dread  of  suffering, 
its  real  severity  under  many  surgical  operations,  the. serious 
tendency  of  pain  to  depress  the  nervous  system  and  to 
produce  death,  the  struggles  andwrithings  of  the  patient, — 
all  these  were  serious  obstacles  to  a  successful  practice  of 
surgery.  What  a  different  spectacle  now  !  The  patient 
in  tranquil  narcosis,  without  pain,  without  will,  without 
struggles ;  the  surgeon  operating  with  ease,  with  care,  and 
a  firm  hand ;  the  patient  returning  to  consciousness  with 
comparatively  little  pain  beyond  the  seldom  very  disagree- 
able after-effects  of  the  narcotization !  All  this  certainly 
is  a  great  benefit  to  the  afflicted. 

It  is  true  that  death  from  the  inhaling  of  chloroform 
has  occurred,  through  causes  sometimes  known,  sometimes 
unknown.  The  number  of  deaths  so  produced  bears  a 
very  small  proportion  to  the  total  number  of  administra- 
tions (only  1  to  10,000  according  to  some).  Nevertheless, 
its  use  requires    all  possible  precaution.     But  to  outlaw 


ON   THE   USE   OF   MEDICINES.  37 

chloroform  from  the  materia  medica  on  this  account,  is 
absurd ;  and  Clarus  *  is  entirely  wrong  when  he  says, 
because  of  the  possibility  of  death  ensuing  from  its  em- 
ployment :  ''  Chloroform  can  not  be  reckoned  among  the 
fortunate  acquisitions  of  modern  times."  The  possibly 
fatal  result  of  its  administration  requires  only  : 

1.  A  careful  investigation,  before  employing  it,  in  order 
to  ascertain  whether  the  constitution  of  the  patient  is  such 
that,  according  to  experience,  death  may  be  easily  produced 
by  chloroform. 

2.  Carefulness  not  to  employ  it  unnecessarily,  viz. :  only 
then  when  the  nature  of  the  operation,  its  severity,  or  its 
long  duration,  renders  the  use  of  chloroform  very  useful,  or 
even  necessary. 

Both  these  precautions  are  often  neglected  j  and  such 
negligence,  even  although  it  may  not  always  have  a  fatal 
result,  is,  nevertheless,  always  objectionable,  and  reckless 
even  to  criminality.  There  is  no  need  of  naming  here 
the  operations  in  which  chloroform  may  or  may  not  be 
used.  Indeed,  its  prudent  use  depends  so  much  upon  the 
peculiar  conditions  and  on  the  specific  nature  of  the  patient's 
case,  that  it  would  not  be  easy  to  do  so.  It  may  be  broadly 
stated,  however,  that  neither  patient  nor  physician  can  be 
allowed  to  use  chloroform  except  for  urgent  reasons. 

I  add  some  remarks  on  the  use  of  chloroform  in  obstetric 
pr-actice.  The  English  physicians  use  it  extensively. 
Of  late  years,  there  has  also  been  in  Germany  a  tendency 
to  the  use  of  it  during  the  more  painful  and  tedious 
obstetric  operations,  just  in  the  same  manner  as  in  surgery. 
There  would  seem  to  be  no  objection  to  this  at  fii'st  sight : 
but  who  will  deny  that  obstetric  operations  (the  Csesarean 

*  Clarus,  D.  I.,  Handbuch  der  ArzneimiitelleJire ,  Leipzig,  1856;  pag.  963. 


38  THE   FIFTH    COMMANDMENT. 

operation  included),  even  when  attended  with  great  pain, 
and  of  long  duration,  are,  on  the  whole,  more  easily  endured, 
and  with  less  apprehension  and  fear,  than  other  less  im- 
portant, but  bloody  operations  ?  I  have  performed  all  the 
obstetric  operations  that  are  generally  in  use  (laparotomy 
included),  and  some  of  them  quite  often,  but  I  never  made 
use  of  chloroform;  and  I  always  observed  that  the  pain 
attending  these  operations  affected  the  nervous  system 
very  little  more  than  the  severe  pains  peculiar  to  partu- 
rition. Again,  there  might  be  great  inconvenience  when 
the  patient  has  lost  control  of  muscular  action.  Never- 
theless, I  agree  with  Schroeder,*  who  says  that,  in  general., 
narcotization  during  obstetric  operations  is  a  great  boon 
to  the  patient,  and  an  aid  to  the  accoucheur.  The  use 
of  chloroform  is  certainly  here  allowable,  if  free  from 
danger  to  the  child.  But  may  we  also  use  it  during  con- 
ditions of  normal  labor  ?  I  do  not  speak  here  of  labor- 
pain  which  is  abnormal  J  nor  of  labor  accompanied  by 
convulsions^  but  only  of  that  pain  which  is  physiologically 
incidental  to  parturition.  Such  relief  of  normal  labor-pain 
by  chloroform  would  be  allowable,  provided  it  be  not 
injurious  to  mother  or  child.  But  certainty  on  this  very 
point  has  not  yet  been  reached.  Setting  aside  the 
possibility  of  the  mother's  sudden  death  during  narcotiza- 
tion, it  cannot  be  denied,  so  far  as  present  experience  goes, 
that  there  is  danger  to  the  child  when  the  mother  is  put 
under  the  influence  of  chloroform.  Experience,  as  well  as 
investigation,  shows  that  the  effects  of  the  drug  are  com- 
municated to  the  foetus.t  Of  course  the  child's  organism 
must  be  expected  to  have  less  power  of  resisting  such  a 

*  Schroeder,   Prof.    Dr.    Karl,  Lehrbuch  der  Geburtshilfe,  IV  Auttage: 
Bonn.  1874,  pag.  '200. 

t  Zweifel   {Berliner  Kliniscke   Wochenschri/t,  1874,  No.  21)  lias   sliown, 


ON    THE   USE    OF   MEDICINES.  39 

poison,  and  to  be  unable  to  secrete  it  so  quickly,  because 
there  is  no  direct  respiration :  and  thus  the  foetus  will  the 
more  easily  succumb  to  it.  Not  to  mention  the  usual  evil 
after-effects  of  chloroform :  narcosis,  vomiting,  etc.,  there 
is  also  positive  danger  to  the  mother  from  the  use  of 
chloroform,  as  the  contracting  powers  of  the  muscles  of 
the  womb  become  less  energetic,  and  parturition  becomes 
thereby  retarded  ;  whilst,  after  parturition,  there  ensues 
danger  of  severe  hemorrhage  by  reason  of  defective  uterine 
contraction.  Schroeder  himself,  who  advocates  the  use 
of  chloroform  during  the  normal  condition  of  labor  attended 
with  intense  pain,  does  not  deny  this,  and  advises  the  use 
of  chloroform  only  so  far  as  is  necessary  for  the  relief  of 
pain,  but  not  for  inducing  a  condition  of  unconsciousness 
(1.  c,  pag.  201).  At  the  same  time  he  says,  only  two 
sentences  before,  that  ^^ absolute  narcosis"  (with  uncon- 
sciousness) of  women  in  labor  "  ensues  often  after  a  few 
inhalations"  (viz.,  of  chloroform).  What  security,  then, 
have  we  here  against  the  chances  of  evils  to  follow  ? 

I  think  these  considerations  suffice  to  show  that  chloro- 
form should  not  be  made  use  of  in  a  normal  state  of  labor. 
The  pains  during  labor  are  sometimes  intense,  but  they 
are  never  intolerable ;  and  in  most  cases  they  are  endared 
with  a  courage  that  seems  to  beget  a  forgetfulness  on  the 
part  of  the  patient  surprising  to  others.  If  the  generation 
of  our  days  is  really  so  effeminate  and  delicate  as  to  require 
artificial  relief  from  the  hardships  incidental  to  a  natural 
process,  it  certainly  is  not  a  step  in  the  right  direction. 
Nay,  our  women  should  rather  be  educated,  body  and  soul, 
to  have  the  courage  and  power  of  endurance  which  nature 

from  five  cases,  that  there  is  chloroform  present  in  the  placenta  or  in  the 
urine  of  the  child,  when  the  mother  is  put  under  the  influence  of  chloroform 
during  parturition. 


40  THE   FIFTH    COMMANDMENT. 

has  bestowed  on  their  sex ;  and  they  should  bo  taught  to 
view  correctly  their  high  vocation,  and  the  duties  belonging 
to  it.  They  would  not  then,  I  am  sure,  cry  for  chloroform 
during  the  pains  of  labor ;  but  would  cling  rather  with  a 
redoubled  love  and  devotion  to  the  being  whose  birth  had 
cost  them  such  intense  suffering. 

Mention  must  here  be  made  of  one  more  remedial  agent, 
which,  for  some  time,  was  much  in  favor.  I  would  forbear 
to  mention  it  but  for  the  circumstance  that  spiritualism, 
in  our  days,  is  making  the  greatest  efforts  to  obtain  an 
influence,  and  that  matters  relating  to  it  may  again  become 
subjects  of  controversy.  I  speak  of  animal  magnetism  as 
a  remedy.  This  animal  magnetism  is,  at  the  present  mo- 
ment, a  phenomenon  as  little  understood  as  somnambulism 
and  clairvoyance.  No  satisfactory  scientific  explanation 
is  forthcoming  of  these  latter  manifestations^  physiological 
or  psychological.  Still  less,  hitherto,  can  science  account 
for  the  pretended  facts  of  artificial  somnambulism,  super- 
induced by  the  process  of  magnetism ;  or  again  for  the 
cures  attributed  to  this  treatment. 

Scientific  physicians,  so  far,  do  not  recognize  animal 
magnetism  as  a  trustworthy  agent,  but  are  disposed  rather 
to  consider  it  charlatanism  and  swindling. 

Theologians,  on  the  other  hand,  are  inclined  to  regard 
animal  magnetism,  in  its  eff'ects,  as  principally  demoniacal,* 
because  persons  thrown  into  magnetic  sleep,  or  while  in  a 
state  of  clairvoyance,  perform  actions  f  which  cannot  result 
from  natural  causes,  viz. :  reading  with  closed  eyes  books 

*  See  the  notes  of  Ballerini  in  Gury,  1.  c.  torn,  i,  pag.  238  flF.,  and  Perrone» 
S.  J.,  Praelectloncs  thenllgicae  de  virtute  religionis  deque  vitlis  oppositis, 
nominatim  verode  Mesmerism!.,  Somnambulismi  ac  Spiritlsmi  recentioH  super- 
stitionc.     Ratisbonae  et  Xeo  Eboi'aci.  18(j6  :  Pustet. 

t  See  Gurv,  1.  c,  torn,  i,  pag.  218  :  Postulatum  Episcopi  Lausanensis  circa 
magnetismum. 


ON    THE   USE    OF   MEDICINES.  41 

open  or  slmt,  in  languages  to  tliera  otherwise  unknown  ; 
giving  information  of  their  own  diseases,  or  of  those  of 
others,  in  technical  terms  at  other  times  to  them  entirely 
unknown  ;  describing  interior  organs,  as  if  they  were  open 
before  their  eyes,  although  they  have  otherwise  no  know- 
ledge of  them  ;  foretelling  precisely  how  long  a  disease  will 
last ;  specifying  simple  and  certain  means  against  diseases, 
although  they  are  wholly  uneducated  and  ignorant  in  such 
matters,  and  do  not  remember  anything  about  the  knowledge 
they  have  communicated  wlien  awake,  etc.,  etc.- 

As  it  must  be  regarded  as  blasphemous  to  think  that 
God  would  act  every  time  directly  at  the  bidding  of  men 
who  are  often  anything  but  pious,  or  that  he  would  alter 
the  laws  of  nature  as  often  as  it  may  please  them,  such 
preternatural  manifestation  must  be  ascribed  to  demoniacal 
influences.  Physicians  and  theologians  are,  in  my  opinion, 
right,  each  from  his  own  standpoint.  If  some  persons, 
-while  thrown  into  a  magnetic  condition,  have  really  per- 
formed such  acts  as  those  above  related,  then  Debreyne  " 
goes  too  far  when  he  says;  "All  those  alleged  phenomena 
must  be  ascribed  to  human  ^artifice,  viz.:  to  jugglery,  to 
imposture,  coincidence,  or  mistake,  and  not  to  the  inter- 
vention of  a  supernatural  agent  or  a  demon." 

The  using  of  animal  magnetism  as  a  means  of  curing 
disease  is  forbidden,  because  : 

1.  Its  effect  must,  at  least  probably,  be  ascribed  to  demoni- 
acal influence  ;  and  we  are  strictly  forbidden  to  have  any 
communication  with  demons. 

2.  The  phenomena  produced  by  magnetism  are  dangerous 
to  faith  and  morals. 

3.  That  is  per  se  forbidden  which  is  done  by  persons 

*  L.  c,  pag.  275. 


42  THE    FIFTH    COMMANDMENT. 

thrown  into  magnetic  condition,  namely  :  tlie  placing  one's 
reason  and  will  entirely  under  control  of  another  person 
(the  magnetizer),  so  that  this  person  can  govern,  use  and 
abuse  mind  and  body  (of  the  individual  magnetized)  ac- 
cording to  the  magnetizer's  will. 

4.  To  make  use  of  animal  magnetism  is  not  compatible 
with  the  duties  each  one  owes  to  his  own  life  and  health  ; 
as  the  adherents  of  magnetical  treatment  *  themselves  say 
that,  if  not  death  itself,  other  grave  disorders  of  mind  and 
body  will  result  from  its  application. 

The  same  applies,  of  course,  to  questioning  persons  who 
have  apparently  been  thrown  into  the  clairvoyant  or 
somnambulistic  condition,  of  their  own  accord,  about  proper 
cures  or  remedies,  because  their  statements  also  are  due 
either  to  imposture  or  to  demoniacal  influence. 

It  will  be  as  well,  here,  to  make  a  few  remarks  on  two 
subjects,  which,  although  not  properly  remedial  agents,  may 
yet  fitly  be  treated  here,  viz.:  vcacination  and  wet-nurses. 


VACCINATION. 

Ever  since,  by  the  laws  of  the  Empire,  the  vaccination  of 
every  body  has  become  compulsory,  there  has  been  a  some- 
what violent  agitation  against  it,  although  the  agitation  has 

*Eiinemoser,  Dr.  Joseph,  Der  Magnetismus  im  Verhaeltniss  zu  Naf.ur  unci 
Heligion,  in  Aufl.  1853,  says,  page  12.  ff.  :  "Not,  seldom  we  have  tlie  direct 
coiitjaiy  (of  success).  A  sensation  of  languor  is  experienced,  sensations 
of  ^veii;ht  in  the  limbs,  inactivity  of  the  muscles,  stiaining  and  pnlling  in 
the  same,  weakness  and  exhaustion,  yawning,  labored  breatliing,  and 
shortness  of  breath,  accompanied  by  all  kinds  of  disorders,  especially  of 
the  abdomen  .  .  febrile  affections,  local  congestions  of  the  blood,  cramps  in 
the  stomach  and  breast,  epilepsy.  Especially  cramp  affections  appear  often 
after  the  first  and  short  magnetizing,  also  hysterical  and  epileptical  attacks 
and  convulsions  of  the  limbs  (page  224).  Even  apparently  healthy  people, 
when  being  magnetized,  become  affected  by  various  sensations,  and  hiuden 
dispositions  to  disease  are  manifested,  ofien  immediately.*' 


•  VACCINATION.  43 

been  incited  by  only  a  few.  Aside  from  personal  rancorous 
attacks  and  mean  insinuations,  the  following  three  reasons 
are  paraded  by  the  opponents  of  vaccination  : — 

1.  Vaccination  affords  no  protection  against  small-pox. 

2.  By  vaccination  from  one  human  subject  to  the  other, 
diseases  are  communicated  from  person  to  person. 

3.  Compulsory  vaccination  is  an  unwarrantable  attack 
upon  the  personal  liberty  of  a  citizen. 

Ad  1.  Vaccination,  properly  performed,  protects  during 
a  certain  period  (from  five  to  ten  years)  against  contagion  ; 
and,  even  in  case  of  contagion,  the  disease  is  developed 
in  a  much  milder  and  less  dangerous  form  than  in  persons 
who  have  not  been  vaccinated. 

The  truth  of  this  assertion  receives  strong  confirmation 
from  the  fact  that,  since  vaccination  was  introduced, 
epidemic  small-pox  has  not  committed  such  fearful  ravages 
as  it  did  before  vaccination  came  into  general  use. 

Ad  2,  In  a  few  cases,  syphilis  has  been  communicated 
from  one  child  to  the  other.  This  alone  has  been  j^^oved. 
But  the  damage  done  to  a  few  individuals  is  more  than 
counterbalanced  by  the  immense  profit  that  accrues  to  the 
whole  of  mankind  from  the  protection  vaccination  affords 
against  the  malignant  disease  of  small-pox.  Moreover, 
it  is  a  proved  fact  that  this  communication  of  diseases  can 
be  avoided  when  proper  care  and  precaution  are  taken  in 
selecting  and  taking  off  the  virus.  A  good  thing  should  not 
be  condemned,  because  it  may  be  abased.  ^'  Vaccination,'^ 
says  Reclam,  "  may  be  best  compared  to  a  lightning-rod, 
which,  when  improperly  affixed,  may  damage  the  house ; 
just  as  vaccination  may  be  of  detriment  to  the  individual, 
when  improperly  applied.  But  who  will  wage  war  on 
lightning-rods  on  this  account?" 

Ad  3.   Personal  liberty,  in  human  society,   cannot   be 


44  THE   FIFTH    COMxMANDMENT. 

unlimited.  Limitations  thereof  in  the  interest  of  society, 
which,  in  the  end,  even  benefit  the  individual,  cannot  be 
avoided.  If  important  interests  of  society  are  at  stake, 
which  are  promoted  by  an  unimportant  restraint  of  per- 
sonal liberty,  the  individual  must  bear  the  restraint. 
Obviously,  the  reduction  of  the  rate  of  deaths  from  the 
destructive  disease  of  small-pox  is  an  object  of  the  utmost 
importance  to  society  at  large ;  and  that  this  reduction  of 
the  death-rate  is  effected  by  vaccination,  has  been  demon- 
strated by  the  testimony  of  an  overwhelming  majority  of 
experts,  who  have  drawn  their  conclusions  from  experience 
and  from  statistical  returns.  It  is  proved,  moreover,  that 
the  diminution  of  the  small-pox  death-rate  proceeds  pari 
passu  with  the  use  of  vaccination.  It  is,  consequently, 
not  only  desirable,  but  even  necessary,  for  the  general  wel- 
fare, that  every  one  should  be  subjected  to  its  protective 
influence.  The  operation  of  vaccination  is  so  exceedingly 
simple,  that  the  trouble  of  its  administration  is  not  worth 
considering  in  comparison  with  the  immense  benefit  it 
confers  upon  the  individual  as  well  as  upon  the  community. 
Society,  therefore,  has  the  right  to  demand  that  every 
individual  should  undergo  the  trifling  inconvenience  to 
which  vaccination  subjects  him — to  make  this  demand  in 
the  form  of  law,  and  to  impose  fines  upon  those  who  are 
not  willing  to  submit  to  a  little  sacrifice  of  their  personal 
liberty  for  their  own  private  welfare,  as  well  as  that  of  the 
community. 

England,  a  country  that,  more  than  any  other,  has  the 
most  jealous  care  of  personal  liberty,  has  been  the  first  to 
introduce  compulsory  vaccination.  I  do  not  hesitate  to 
say  that  we  are  Jiving  in  the  golden  age  of  liberty,  if 
there  be  no  worse  compulsion,  in  our  modern  states,  than 
compulsory  vaccination. 


WET-NURSES.  45 

In  regard  to  tliis^  as  well  as  other  sanitary  measures, 
especially  in  times  of  epidemics  and  contagious  diseases, 
priests  can  render  great  service  by  aiding  them  both  by 
word  and  example.  Thus  the  epidemic  itself,  and,  what 
is  worse,  the  dread  of  it,  as  well  as  the  excitement  it  oc- 
casions, may  be  restrained  within  narrower  limits. 


ON  WET-NUESES. 

I  approach  this  subject  with  the  full  consciousness  that 
I  am  about  to  bring  a  hornet's  nest  about  my  ears,  and  that 
I  shall  encounter  much  contradiction.     Be  it  so. 

Mother's  milk  is  the  most  natural  nourishment,  nay,  the 
only  proper  one,  for  the  child.  No  other  /ood  can  be  a 
perfect  substitute  for  it.  Science,  in  spite  of  her  utmost 
efforts,  has  not  succeeded  in  finding  one.  It  is  proved, 
beyond  a  doubt,  that  the  rate  of  mortality  amongst  infants 
raised  in  any  artificial  manner  is  far  larger  than  amongst 
children  raised  by  nursing.  This  fact  alone  establishes 
the  positive  obligation  of  the  mother  to  nourish  her  infant 
with  her  own  milk,  and  not  to  withhold  from  it  the  food 
given  her  by  God  for  this  purpose. 

Are  there,  however,  any  reasons  which  may  excuse  a 
mother  from  the  duty  that  nature  exacts  ? 

Gury  says:*  ''  Mater  filiolos proprio  lade  nutrire  debet 
(sententia  communis),  quia  hoc  jus  naturale  postulare  videtur, 
Attamen  Jiaec  obUgatio  non  urget  suh  gravi,  quia  non  apparct 
secus  gravis  dcordinatio.  Ah  omni  autem  culpa  excusat  ne- 
cessitas,  notahilis  titilitas,  aut  consuetudo  apud  familias 
nohiles  vigens,  etc.  ;  sed  tunc  suh  graui  mater  honam  quoad 
mores  et  valetudinem  nutricem  sihi  suhstitiiere  dehetP 

*  Gary,  1.  C;  torn,  i,  pag.  361. 


46  THE  FIFTH    COMMANDMENT. 

I  cannot  admit  that  this  obligation  does  not  bind  siib 
gravis  because  it  is  a  proved  fact  that  many  infants  pine 
and  die  in  consequence  of  having  been  denied  the  nourish- 
ment of  their  mother.  The  child's  death,  which  of  course 
does  not  follow  as  a  necessary  result,  but  which  may,  and 
does  too  often,  happen  in  consequence,  is  most  certainly  a 
grave  deordinatio.  Were  the  death  of  the  infant  which 
had  been  deprived  of  its  mother's  milk  a  certain  and  neces- 
sary result,  then  the  withholding  of  the  natural  nourishment 
without  sufficient  reason  would  be  more  than  a  deordinatio  : 
it  would  be  murder.  The  law  of  nature  is  that  every 
new-born  infant  shall  be  fed  with  the  milk  of  its  oivn  mother ; 
and  for  this  purpose  is  the  mother  provided  with  it.  The 
child  has,  thus,  a  natural  claim  to  the  milk  of  Us  own 
mother ;  and  to  the  mother  belongs  the  natural  duty  of 
giving  to  her  offspring  the  milk  afforded  by  nature  for 
precisely  this  child.  To  abandon  this  duty  is  to  thwart  a 
fundamental  law  of  nature,  and  is,  in  my  opinion,  a  grave 
deordinatio.  I  believe  that  too  much  stress  has  been  laid 
upon  the  circumstance  that  it  is  possible  for  a  wet-nurse 
to  fill  the  place  of  the  mother.  But  whether  it  diminishes 
the  gravity  of  an  obligation,  that  it  is  possible  to  transfer 
the  duty  to  a  third  person,  notwithstanding  the  fact  that 
nature  has  clearly  defined  the  way  of  fulfilling  it,  is  a 
question  I  leave  to  the  moralists. 

We  must  now  consider  the  reasons  which  may  excuse  a 
mother  from  the  duty  of  nursing  her  child,  *^  without  any 
fault  on  her  part."  Of  those  quoted  by  Gury,  the  one, 
*^  necessity," — for  instance,  on  account  of  sickness  and 
debility  of  the  mother, — is  of  course  sufficient;  likewise 
pregnancy  supervening  during  the  period  of  nursing, 
because  the  organism  generally  is  not  able  to  meet  both  of 
these  duties,  without  injury  to  the  mother  or  the  children. 


WET-NURSES.  47 

^^  Notahilis  utilitas^^^  given  by  Guiy  as  a  second  reason, 
may  also  pass  as  valid.  If,  for  instance,  a  woman  cannot 
pursue  some  vocation  that  is  nessary  for  her  decent  support, 
then  she  may  be  excused  from  nursing  propter  notahilem 
utilitatem.  The  same  will  apply  to  the  mother  whose 
health,  although  not  strictly  forbidding  the  nursing  of  her 
infant,  may  yet  derive  a  notahilem  utilitatem  from  not 
nursing  it. 

The  third  reason  given  is  consuetudo  apud  famiUas 
nohiles  vigens.  Scavini  *  does  not  give  this  reason  in  the 
text,  but  he  simply  mentions  it  in  a  note  :  ''  Excusant  etiam 
feminam  nobi.lem  oh  consuetudinem  Salmanticenses,  Navar^ 
ruSy^  etc.  Is,  then,  a  mere  consuetudo  to  be  accepted  as  a 
sufficient  dispensation  from  so  grave  an  obligation  ?  Is 
custom  to  excuse  from  sin  one  who  neglects  a  positive 
duty  imposed  upon  him  by  the  laws  of  nature  ? 

It  is  said :  "  We  admit  that  this  custom  is  an  abuse, 
and  that  they  were  guilty  who  introduced  it.  But  the 
custom  has  obtained  for  generations  :  we  find  the  custom 
prevailing,  and  we  follow  it  bona  fide^  Let  it  be  granted 
that  a  person  is  excused  from  sin  who  follows  a  bad  custom 
bona  fide.  Yet,  I  cannot  admit  the  validity  of  the  excuse 
here.  In  the  first  place,  hona  fides  cannot,  in  this  case,  be  so 
easily  proved ;  for  the  voice  of  nature  makes  itself  heard 
in  the  heart  of  ii\ery  mother,  urging  her  to  give  to  her  infant 
its  mother's  nourishment,  through  so  many  physical  and 
psychical  phenomena.  In  the  second  place,  it  is  generally 
not  custom  which  induces  a  mother  to  refuse  its  natural 
nourishment  to  her  child,  but  the  very  reasons  which  origi- 
nated the  evil  custom  itself;  which  still  support  it,  and  exert 
their  influence  on  every  mother  who  follows  the  custom  : 
such  as,  vanity,  love  of  pleasure,  excessive  delicateness,  etc. 

*  L.  C;  torn,  i,  pag.  456. 


48  THE   FIFTH   COMMANDMENT. 

How  is  it  that  only  a  femina  nohilis  is  excused  by  cus- 
tom ?  Are  the  duties  which  Nature  calls  for,  in  the  noble, 
different  from  those  she  demands  from  the  unennobled  ? 
Besides,  nowadays,  this  custom  is  by  no  means  restricted 
to  nobility.  Are  noble  mothers  who  follow  this  custom 
excused  from  all  sin  ;  and  are  those  of  ignoble  descent  only 
excused  from  grave  guilt  ?  In  my  opinion,  the  requirements 
of  nature  allow  no  distinction  between  Jiomincs  nohiles  and 
noii  nohiles.  Man  is  man  ;  and  all  owe  the  same  obligation 
to  the  divine  law,  as  well  as  to  that  of  nature.  Perhaps  it 
was  thought  that  noble  mothers  have  means  to  pay  for  wet- 
nurses,  and  others  have  not.  As  I  said  before,  there  is  too 
much  stress  laid  on  this  circumstance. 

Unfortunately,  however,  the  custom  of  mothers  abandon- 
ing the  duty  of  nursing  their  children,  without  sufficient 
reason,  obtains  more  and  more.  To  preserve  physical 
beauty,  to  avoid  inconvenience, — for,  of  course,  ladies  who 
are  nursing  children  cannot  attend,  without  inconvenience, 
concerts,  balls,  gossipings,  tea-parties,  etc., — even  for 
reasons  still  more  frivolous,  too  many  mothers  try  to  avoid 
this  first  and  noblest  duty  of  the  mother,  and  place  a 
wet-nurse  in  their  stead.  This  is  the  hornet's  nest  to 
which  I  alluded  above.  A  mother  is  obliged,  and  suh  gravi, 
to  have  her  place  taken  by  a  nutrix  bona  quoad  mores  et 
valetudinem.  This  is  an  admirable  obligation,  because  no 
one  can  deny  that  not  only  the  child's  body,  but  its  soul 
also,  is  influenced  from  the  wet-nurse.  Is  there  attention 
paid  to  this  injunction!  Certainly,  we  are  answered,  our 
ffiniily  physician  has  examined  the  person  thoroughly, 
and  has  pronounced  her  healthy  and  a  good  wet-nurse. 
But  as  to  morals  ?  It  would  seem  to  be  generally  taken 
as  sufficient  if  the  person  is  questioned  and  found  to  be 
of  placid  temperament,  intelligent,  active,  truthful,  honest, 


WET-KUliSES.  49 

etc.,  etc.  One  point,  however,  and  that  the  most  important, 
is  not  attended  to,  viz. :  the  moral  condition  of  the  nurses 
quoad  sextum  praeceptum.  A  woman  that  has  fallen,  even 
more  than  once,  is  accepted  as  wet-nurse,  with  an  ease  and 
levity  that  must  cause  wonder  and  horror.  Such  a  person 
to  nourish  the  child,  to  be  always  with  it,  to  give  it  its 
earliest  training !  Can  such  as  she  be  a  niitrix  bona  quoad 
nvares  f  We  shall  be  told  :  ^^  I  should  prefer  a  moral  woman, 
but  they  are  not  to  be  had.  Besides,  it  cannot  matter  so 
much  :  all  do  it."  Yes,  for  shame  !  It  also  has  become  a 
custom !  If  a  mother,  who  was  really  unable,  for  good 
reasons,  to  nurse  her  child  herself,  should  see  the  child 
suffering  for  want  of  milk  ;  if  she  observed  that  it  did  not 
thrive,  but  grew  sickly,  and  would  probably  die  if  no  wet- 
nurse  were  procured ;  if,  in  such  a  case,  she  reluctantly 
consented  to  have  a  fallen  woman  as  nurse  for  her  child, 
because  a  virtuous  woman  could  not  be  had,  we  should 
not  blame  her.  But  our  modern  ladies,  who  do  not  nurse 
their  children  on  account  of  custom,  scarcely  inquire  into 
this  point,  provided  the  wet-nurse  is  healthy,  that  is,  bodily. 
Is  it  not  horrible  that  the  physician  who  is  called  upon  to 
judge  of  the  fitness  of  the  wet-nurse,  must  first  and  fore- 
most examine  whether  she  suffers  from  lues  venerea  f 
Every  physician  can  testify  to  this.  Even  the  much- 
sought  ''nurses  from  the  country"  fare  no  better.  Now- 
adays immorality  infects  rural  districts  to  such  an  extent, 
that  the  wet-nurses  from  the  country,  whose  number  has  in- 
creased a  thousand-fold,  are  not  above  suspicion  of  syphilis, 
I  loudly  aver, — and  clergymen  and  country  physicians 
corroborate  my  statement, — that  the  employment  of  wet- 
nurses  has  had  a  deteriorating  influence  upon  the  morality 
of  rural  districts.  Formerly,  a  fallen  girl  in  a  small  com- 
munity came  to  shame  and  grief,  and  had  often  to  endure 


50  THE    FIFTH    COMJkEANDMENT. 

poverty  and  misery  for  her  lifetime.  Nowadays,  the 
fallen  woman  leaves  the  place  after  or  before  confinement, 
puts  her  child  out  to  board,  and  is  sure  to  find  very  soon  a 
good  place  as  wet-  nurse.  As  such,  she  leads  an  easy  life, 
gets  good  pay,  and  is  able,  not  only  to  pay  easily  the 
expenses  of  boarding  her  child,  but  even  of  setting  some- 
thing aside.  There  are  persons  who  like  this  way  of  living 
so  well,  that  they  try  to  regain  the  faculty  of  nursing,  when 
they  have  lost  it.  I  myself  know  of  such  cases.  It  is  said 
to  occur  even  that  girls,  hitherto  not  fallen,  try  to  acquire 
this  faculty,  either  only  half  or  entirely  conscious  of  the  crime 
they  commit  for  that  purpose.  This  is  one  of  the  many  evil 
consequences  of  this  unnatural  custom.  Who  knows  how 
many  children  perish,  because  their  mothers  do  a  mother's 
duty  for  strange  children?  The  '^AerztUche  VereinsblaW^ 
(1876,  No.  55)  says  that,  ^' owing  to  this  circumstance'' 
(namely,  mothers  of  illegitimate  children  boarding  out  their 
off'spring),  "  thousands  of  children  perish  yearly  in  the  state 
of  Prussia."  Is  there  not  a  responsibility  resting  on  mothers 
who,  without  sufficient  cause,  but  simply  in  deference  to  cus- 
tom, procure  w^et-nurses  and  pay  them  high  wages  f  JMast 
not  a  great  share  of  guilt  of  the  above  evil  consequences  rest 
on  such  mothers?  Do  not  the  misfortunes  of  those  neg- 
lected children,  who  piue  and  die  for  want  of  attendance 
and  mother's  milk,  cry  to  heaven  against  those  women  who, 
without  necessity,  have  deprived  tlicm  of  their  mothers! 

It  would  seem  that  the  older  moralists  could  not  estimate 
at  their  proper  value  the  evil  consequences  and  damaging 
effects  of  mother-substitutes  on  body  and  soul,  because,  in 
former  times,  when  wet-nurses  were  seldom  employed, 
those  consequences  either  did  not  exist,  or  did  not  come  to 
light.  They  must,  however,  most  certainly  be  considered 
with  reference  to  the  question  at  issue  :   whether,  viz.,  a 


WET-XUKSES.  51 

mother  may  abstain  from  nursing  her  child  merely  out  of 
respect  for  custom,  without  any  sin  on  her  part,  or  may, 
without  any  reason,  neglect  this  duty  of  a  mother,  sub  levi. 
As  matters  stand  at  present,  when  the  custom  of  employing 
wet-nurses  has  become  so  general,  I  do  not  know  whether 
the  moralists,  even  those  who  do  not  rank  as  rigidiores, 
can  admit  any  longer  the  custom,  in  general,  *  as  a  sufficient 
reason  to  abstain  from  nursing ;  and  whether  they  will  not 
regard  mothers  as  bound  sub  gravi  to  nurse  their  own 
children,  so  long  as  they  are  not  justified  by  sufficient 
reasons  in  abstaining  from  fufilling  this  law  of  nature. 

To  physicians  belongs  no  small  proportion  of  respon- 
sibility for  the  existence  of  this  nuisance ;  because  they 
neglect  to  impress  upon  mothers  their  duty  of  nursing, 
and  fail  to  convince  them  not  only  that  the  fulfilment  of 
this  duty  by  mothers  is  a  source  of  the  highest  pleasures, 
but  also  that  it  increases  their  real  beauty,  and  is  subser- 
vient even  to  their  health.  For  a  forcible  suppression  of 
a  natural  function  is  always  injurious.  A  motlier  nursing 
her  child,  if  she  is  otherwise  healthy,  is  a  picture  of  fulness 
of  health,  and  is  apparently  elevated  to  the  acme  of 
human  growth  and  human  beauty.  Ask  a  true,  good 
mother  whether  there  is  a  happiness  which  she  Avould  ex- 
change for  the  pleasures  and  enjoyment  the  nursing  affords 
her;  ask  only  those  to  whom  nature  has  denied  this 
happiness,  how  they  long  for  it.  It  would  be  vain  to  ask 
those  devotees  of  fashion,  ball  and  party-goers,  for  they 
will  of  course  complain,  and  will  worry  and  beseech  the 
^^dear  doctor"  till  he  is  weak  enough  to  order  a  wet- 
nurse.  And  here  arises  a  second  point  wherein  the  doctor 
is  often  at  fault.  Doctors,  better  than  others,  understand 
the  evils  resulting  from  the  employment  of  wet-nurses ; 

*  Thera  wiH  be,  of  course,  always  excepticns. 


52  THE   FIFTH    COMMANDMENT. 

but  it  seems  as  if  it  were  not  in  their  power  to  say  9io. 
This  is  unworthy  of  a  man.  Should  there  be  no  sufficient 
reason  for  excusing  the  mother^  nothing  should  induce 
the  doctor  to  wink  at  wrong-doing ;  nor  should  he  act  at 
variance  with  his  honest  convi'ction,  even  at  the  peril  of 
moping  fits  and  displeasure  of  his  patients.  If  such  a 
course  were  pursued,  the  use  of  wet-nurses  would  soon  be 
reduced  to  its  proper  limits,  and  would  cease  to  be  the 
abuse  it  has  become. 

In  connection  with  the  fifth  commandment,  I  propose  to 
offer  a  few  suggestions  on  the  vice,  or,  as  others  call  it,  the 
*^  moral  disease,"  of  intemperance,  especially  drunkenness  ; 
and  I  will,  at  the  same  tfme,  treat  shortly  of  other  physical 
infirmities  often  met  with,  and  which  require  considerate 
treatment  on  the  part  of  the  priest,  viz.:  hysteria,  hypochon- 
driasis; and  the  mental  diseases. 


INTEMPERANCE,  DRUNKENNESS. 

"  Gida,  id  est,  inordinaUis  appetifus  cibi  velpotus,  est  pec- 
cattim  veniale  ex  genere  suo.  Fit  autem  grave j  si  graviter 
noceat  sanitati,  aid  si  quern  ad  officiiim  ineptum  reddatJ^ 
(Gury,  1.  c,  tom.  i,  pag.  156.)  Is  habitual  intemperance 
in  eating  or  drinking, — which,  when  continued,  is  always 
hurtful  to  health, — a  mortal  sin  ? 

Gluttony  is  the  vice  of  the  upper  classes  of  society  chiefly, 
amongst  whom  meat  and  drink  are  often  taken,  not  to 
satisfy  the  hunger  or  strengthen  the  body,  but  only  to 
please  the  appetite.     ^^  Such  men  eat,"  says  Hartmann,* 

*  Hai'tmann,  Ph.  Carl,  Prof.,  Dr.,  Glaccksellf/keitslehre  fuer  das  phi/ si sr he 
Leben  des  Menschan.  Unvjearbeitct  von  Moritz  Schrebei' :  X  Aufl.  Leii)2ig : 
Carl  Geibel :  187tj. 


INTEMPERANCE,  DRUNKENNESS.  53 


"  as  long  as  their  palate  is  sensible  of  enjoyment ;  and 
because  they  eat  one  richly-flavored  food  after  another, 
their  relish  for  food  is  kept  up  longer  than  needed.  The 
consequence  is  that  they  eat  to  excess  at  nearly  every 
meal.''  The  results  soon  show  themselves.  At  first,  the 
overloading  of  the  stomach  leads  to  imperfect  digestion, 
accompanied  by  flatulency,  cramps  in  the  stomach,  colics, 
want  of  appetite,  congestion  of  the  brain.  Next,  headaches 
render  the  glutton  dull,  and  disinclined  to  any  kind  of 
work.  By  and  by,  deeper  disorders  make  themselves  felt 
in  the  digestive  organs  of  his  body  :  frequent  vomitings, 
constipation  and  diarrhoea  alternating,  stoppages  in  the 
abdomen,  hemorrhoids,  impairing  more  and  more  the 
powers  of  digestion  and  assimilation.  Nutrition  of  the  body 
languishes ;  the  general  discomfort  sometimes  increases  to 
hypochondriacal  lowness  of  spirits  j  the  mental  faculties 
suffer  in  a  more  or  less  pronounced  manner.  In  addition 
to  these  temporary  disorders,  a  great  number  of  acute  and 
chronic  diseases  are  bred  and  nourished  by  the  abuse  of  the 
digestive  organs  in  the  use  of  food. 

A  beneficial  effect  may  possibly  be  produced  by  merely 
pointing  out  these  distressing  consequences,  besides  ex- 
posing the  sinfulness  of  gluttony. 

Oftener  met  with,  however,  is  habitual  intemperance  in 
the  use  of  spirituous  liquors  :  an  excess  which  may  end  in 
the  horrible  vice  of  drunkenness. 

Upon  this  vice  or  disease,  I  will  make  only  a  few  re- 
marks, refraining  from  anything  that  may  pertain  to  the 
pastoral  treatment  of  the  drunkard.  The  consequences  of 
drunkenness  are  but  too  well  known.  In  addition  to  a 
complete  disarrangment  of  the  whole  digestive  system,  and 
generally  of  the  urinary  organs,  symptoms  of  disease  of 
the  nervous  system  are  prominent  in  the  victim  of  drink. 


54  THE    FIFTH    COMMA^'DMEXT. 

His  mental  faculties  become  void  of  any  activity  they 
may  have  been  possessed  of ;  the  patient  is  seized  for  a 
time  with  giddiness^  the  power  of  vision  is  clouded,  the 
tongue  tremulous,  sleep  broken.  In  every  movement 
is  perceived  an  irrepressible  tremulousness  of  hand  and 
fingers ;  before  sleep  he  experiences  sensations  as  of  ants 
crawling  over  him,  and  a  dragging  in  the  calves  of  the  leg, 
finally  reaching  the  arms.  The  mind  is  timid,  irresolute, 
discontented,  hypochondriacal,  querulous,  desperate.  (Hart- 
mann.)  The  strength  of  the  limbs  diminishes  more  and 
more  ;  the  knees  of  the  patient  give  under  him  5  all 
firmness  of  grasp  is  relaxed  ;  and  often  there  supervene 
suspension  of  sensation  and  anaesthesia  in  the  extremities. 
At  last,  attacks  of  vertigo  become  frequent,  hallucinations 
trouble  the  patient,  the  sense  of  sight  and  the  other  senses 
are  impaired — leading  in  the  end  to  real  delirium.  If  the 
progress  is  not  checked  here,  the  mental  faculties  become 
gradually  weaker,  and  the  patient  falls  into  a  dull  stupor, 
from  which  he  is  roused  only,  and  that  only  occasionally, 
by  hallucinations,  delirium,  and  attacks  of  mania.  As  the 
impairment  of  the  senses  increases,  there  is  progressive 
palsy  of  the  limbs.  Amidst  chronic  catarrh  of  the  lungs 
and  diarrhoea,  the  marasmus  reaches  its  lowest  point,  the 
legs  become  dropsical,  and  the  death  of  the  patient  takes 
place,  either  during  quiet  delirium,  or  in  consequence  of 
total  collapse,  unless  a  stroke  of  apoplexy  should  sooner 
end  the  sad  spectacle.  Our  hospitals,  and  still  more  our 
lunatic  asylums,  are  filled  with  the  miserable  victims  of 
drunkenness  and  their  ofi'spring.  \Yeak  and  decrepit,  their 
faces  pale,  their  intellect  deficiently  developed,  exposed  to 
an  early  death,  or  to  the  fearful  ravages  of  scrofula  and 
tubercles,  those  children  of  bestialized  parents  drag,  by 
thousands,  their  weary  load  of  life.     We  know  all  this  5 


55 

cartloads  of  books  have  been  written  on  this  subject,  the 
best  laws  proclaimed  against  the  vice  j  but  nothing  avails 
to  stop  or  check  it. 

The  cure  of  the  drunkard  demands  the  utmost  ingenuity 
of  science.  The  use  of  moral  influence  becomes  nearly 
impossible,  when  the  evil  has  reached  a  certain  stage, 
because  there  is  then  no  moral  strength  left  on  which  to  act. 
Physical  remedies,  and  among  them  the  oddest,  have  been 
all  tried  in  vain. 

The  only  thing  left  is  a  recourse  to  prophylactic  pro- 
cedure. Laws  and  enacted  checks,  sermons  and  private 
remonstrance,  mildness  and  severity,  must  work  together, 
to  hinder  this  vice  at  its  commencement,  and  to  prevent 
its  spreading.  For  this  end,  it  will  do  good  service  to 
impress  vividly,  upon  those  who  display  an  inclination  to 
it,  the  physical  consequences  of  this  vice,  besides  insisting 
on  its  moral  depravity. 

To  cure  an  advanced  drunkard,  there  is,  I  believe,  only 
one  means  :  force.  The  drunkard  cannot  control  himself, 
so  others  must  do  that  for  him.  He  must  be  deprived  of 
spirituous  liquors,  he  must  be  cut  off  entirely  from  every 
occasion  of  obtaining  tliem,  and  his  shattered  organization 
must  be  treated  according  to  the  rules  of  medical  art.  An 
experience  of  twelve  years  as  physician  for  the  poor,  and 
in  the  lunatic  asylum,  enables  me  to  assert,  positively,  that 
there  exists  no  other  cure.  As  this  cure  can  only  be  employed 
by  the  restriction  of  personal  freedom,  as  a  general  rule, 
only  those  come  under  this  proper  treatment  in  whom  mania 
apotu  is  developed;  and  these,  after  having  been  cured  of 
the  mania  J  should  remain  in  the  asylum,  or  in  some  other 
such  institution,  wherein  they  may  be  cured  also  of  in- 
temperance. But  the  law,  jealous  of  personal  liberty,  does 
not  allow  a  longer  restriction  of  personal  freedom ;  so  that 


56  THE   FIFTH    COMMANDMENT. 

the  patient  is  sent  out,  cured,  indeed,  of  delirium,  but  not  of 
drunkenness,  its  cause.  Often  a  few  days  only  are  sufficient 
for  the  restored  maniac  to  plunge  again  into  the  depths  of  his 
damnable  habit ;  either  conducting  him  to  an  early  grave, 
or  subjecting  him,  time  after  time,  to  the  same  delirium,  until 
at  last  he  helps  to  swell  the  number  of  incurable  idiots. 

HYSTERIA. 

Let  me  state,  at  the  outset,  that  hysteria  is,  unequivocally, 
a  disease,  and  that  those  afflicted  with  it  deserve  as  much 
consideration  as  do  other  patients  j  but,  at  the  same  time, 
it  is  both  desirable  and  necessary  to  caution  priests  to 
beware  of  hysterical  persons.  The  reasons  for  thus  caution- 
ing them  will  make  themselves  known  from  what  follows. 

Hysteria  is  deservedly  called  the  most  protean  of  diseases. 
Its  symptoms  throughout  every  portion  of  the  nervous 
system  are  so  numerous,  that,  to  describe  them  all  in  such  a 
manner  that  persons  outside  of  the  medical  profession  will 
be  able  to  easily  recognize  them,  is  absolutely  impossible. 
Of  hysteria,  generally,  it  may  be  stated  that  it  is  "  an  affec- 
tion whereby,  in  consequence  of  a  particular  excitability 
of  the  sensory  nerves,  the  whole  psychical  personality 
undergoes  a  change  j  an  affection  that  modifies  the  percep- 
tive faculties,  fetters  the  will,  hinders  personal  self-activity 
in  all  directions,  and  throws  wide  open  the  door  to  every- 
thing whimsical  and  involuntary."  *  There  is  manifested 
in  most  hysterical  cases  a  morbid  desire  of  exciting  pity 
and  sympathy,  of  becoming  objects  of  interest  and  attention. 
The  slightest  impressions  on  the  sensory  nerves  may  make 
these   persons  complain   of  intense   suffering;   subjective 

'Hasse-,  Krankheiten  des  Nervemijsietm,  pag.  207.     (In  Virchow,  Hand' 
huch  der  speciellen  PcUhologie  und  Therapie.) 


HYSTERIA,  57 

disordered  sensations  are  taken  for  realities,  and  bring  on 
conditions  that  are  similar  to  a  state  of  ecstasy  or  clair- 
voyance. Under  the  outer  garb  of  religious  enthusiasm, 
there  is  frequently  developed  a  sexual  excitement  reaching 
nymphomania,  through  which  persons  around  her,  and 
young  physicians*  and  priests  alike,  are  deceived  to  a 
pitiable  degree.  The  patients  pass,  without  apparent  cause, 
from  extravagant  gaiety  to  deep  melancholy  ;  are  irritable, 
apprehensive,  having  unaccountable  likings  and  dislikings, 
thus  becoming  for  those  around  them  a  perfect  torment. 
Paralytical  affections,  even  complete  palsy  of  all  the 
muscles,  develop,  sometimes  slowly,  sometimes  suddenly ; 
their  duration  is  variable,  disappearing  often  after  years, 
either  gradually  or  suddenly,  with  perfect  restoration  of 
liberty  of  motion.  Many  so-called  miraculous  cures  of 
persons  palsied  for  long  years  may  be  thus  explained.  The 
emotion  whilst  at  the  shrine  of  pilgrimage,  the  touching  of 
the  relics,  have  often  been  enough  to  suddenly  take  away 
the  palsy ;  but  in  the  same  manner  as  hysterical  persons 
who,  after  having  been  long  afflicted  with  paralytical  affec- 
tions, have  sometimes  been  able  to  ran  out  quickly,  when 
their  room  was  on  fire,  or  even  when  they  had  unexpectedly 
received  boxes  on  the  ear  from  friends  to  whom  they  had 
previously  been  the  objects  of  pity  and  of  sympathy.* 

The  so-called  hysterical  paroxysms  are  the  most  alarm- 
ing features  of  this  disease,  "  Unexpected  touches  of  the 
skin,  feeling  of  the  pulse  by  the  physician,  and  the  like, 
even  mere  imaginations  and  psychical  impressions,  etc., 

*  I  do  not,  of  course,  intend  to  deny  that  pei'sons  afflicted  with  hysterical 
palsy,  like  persons  afflicted  with  other  diseases,  have  been  cured  iriracu- 
lously.  But,  as  the  cure  may  have  worked  in  a  natural  way,  and  as  it  is 
very  difficult,  and  generally  impossible,  to  decide,  in  a  single  case,  whether 
the  cure  has  been  miraculous  or  otherwise^  precaution  in  judging  such  cases 
cannot  be  too  much  recommended. 


58  THE   FIFTH    COMMANDMENT. 

bring  on  these  symptoms.  Automatic  movements  of  the 
head  and  of  the  outer  limbs,  squinting,  compression  of  the 
jaws,  as  far  as  grinding  the  teeth,  rolling  of  the  tongue, 
constant  swallowing,  hurried  breathing,  shrieking,  con- 
stantly pronouncing  the  same  words,  uttering  all  sorts  of 
sounds,  as,  for  instance,  barking  (even  really  bellowing 
and  howling),  drawing  backward  the  head,  elevating  the 
pelvis,  struggling  with  the  hands  and  feet,  extending  the 
limbs,  opisthotonos,  pleurosthotonos  and  so  on,  cataleptical 
rigidity  of  the  whole  body, — all  these  symptoms  may  be 
observed  during  attacks,  either  alone,  or  combined  in  a 
diversified  manner.^  *  Thus  epilepsy  and  catalepsy  may 
be  feigned :  such  attacks  may  even  bear  a  resemblance  to 
demoniacal  possessions  by  one  or  more  demons. 

These  few  remarks  will  suffice  to  justify  my  warning 
to  priests  to  use  caution  in  treating  hysterical  persons. 
They  must  take  care  not  to  become  deceived  by  sometimes 
surprising  symptoms,  or  to  be  cheated  by  these  deceitful, 
versatile,  and  persistent  persons.  "  Such  patients,  in  order 
to  satisfy  their  passion  to  pretend,  will  go  through  every 
pain,  exertion,  and  privation  ;  anything  will  be  borne  and 
tried  willingly  rather  than  give  up  the  pretence."  t  As 
the  wrong  ideas,  the  deceptions  practised  by  the  patient, 
either  intentionally  or  otherwise,  are  often  in  the  line  of 
religious  enthusiasm,  of  "  piety,"  priests,  and  especially 
young  ones,  are  apt  to  have  trouble  with  hysterical  persons, 
and  find,  at  last,  often  too  late,  that  it  had  been  better  for 
them  never  to  have  had  anything  to  do  with  them. 

The  cure  of  hysterical  persons,  even  should  their  wrong 
ideas  be  in  the  sphere  of  religious  enthusiasm,  is  in  no 
way  the  priest's  business.     It  can  only  concern  him  to 

•  Hasse;  1.  c,  pag.  212.  t  Ibid.,  pag.  2ia 


HYPOCHONDRIASIS.  59 

know  that  there  is  no  better  means  to  stop  the  alarming 
symptoms  than  to  treat  them  with  absolute  indifference.  In 
order  to  shorten  or  end  paroxysms  with  or  without  con- 
vulsions, cold  water  dashed  upon  the  face  of  the  patient 
is  generally  very  useful.  It  may  not  be  polite ;  but  it  has 
stood  tlie  test,  and  can  do  no  harm. 

To  calm  any  apprehensions,  I  may  add  that  it  is  very 
seldom  that  any  one  dies  of  hysteria,  even  during  a 
hysterical  paroxysm.  For  which  reason,  priests  should 
be  very  careful  in  administering  the  last  sacraments  to 
persons  whom  they  know  to  be  hysterical. 

HYPOCHONDRIASIS, 

The  crux  medlcorum,  is  treated  by  some  writers  on 
pastoral  medicine,  under  Etiology  and  Therapeutics,  at 
great  length.  I  do  not  see  any  reason  for  so  doing.  The 
frequent  pretence  of  piety,  visions,  sham  miracles,  sham 
ecstasies,  etc.,  of  hysterical  persons,  may  bring  them  often 
in  contact  with  priests.  And  it  has  been  to  put  priests  on 
their  guard  against  this  morbid  condition  of  the  nervous 
system  of  women,  and  for  that  alone,  that  I  have  treated 
hysteria  at  some  length.  But  it  is  far  different  with  hypo- 
chondriacs. There  are  no  symptoms  of  the  kind  in  their 
case,  and  thus  there  is  no  particular  intercourse  with  the 
priest.  A  hypochondriac  is  so  much  occupied  in  observing 
and  explaining  all  normal  and  abnormal,  real  and  imagi- 
nary symptoms,  occurrences  and  feelings  of  his  body,  that 
all  his  thoughts  are  fixed  upon  his  sufferings  and  their 
consequences,  and  they  are  the  sole  subjects  of  his  con- 
versation. Moral  treatment  is  of  no  use  with  these  faint- 
hearted, morose,  and  egotistical  patients.  On  the  other 
hand,  they  are  not  very  likely  to  seek  consolation  from  a 


60  THE    FIFTH    COMMANDMENT. 

priest,  unless  the  priest  dabbles  a  little  in  medicine,  or  is,  in 
plain  English,  a  quack.  In  such  men,  priests  or  laymen, 
the  hypochondriac  places  confidence. 

I  am  very  far  from  saying  that  all  the  feelings  of  the 
hypochondriac  should  be  ridiculed,  or  treated  as  "  imagi- 
nary." Although  his  ailments  depend  upon  his  sensibility, 
which  is  active  in  a  wrong  direction,  psychical  alteration 
coexisting  to  a  greater  or  less  degree,  they  are  nevertheless 
severe.  ^'  His  sensations,"  says  Romberg,  ^'  are  fancied  5 
but  from  the  mind  they  possess  the  body."  The  patient 
deserves  the  more  pity,  because  his  condition  is  nearly 
always  incurable.  But,  like  hysteria,  hypochondriasis 
without  complication  is  seldom  fatal. 

In  some  natures  hypochondriasis  degenerates  into  real 
insanity  ;  the  patients  become  also,  sometimes,  victims  of 
suicide.  To  prevent  this  is  nearly  always  impossible, 
because  the  resolution  is  quickly  made,  and  is  immediately 
followed  by  the  deed.  Hypochondriacs  express,  often 
enough,  complete  disgust  with  life,  and  the  intention  of 
ending  their  insufferable  existence  ;  but,  generally,  this 
talk  does  not  amount  to  much,  because  nearly  all  of  them 
show  an  exaggerated  anxiety  for  life  and  health.  Yet 
the  possibility  of  such  a  catastrophe  must  be  kept  in  view  ; 
and  here  is  a  point  which  is  of  practical  interest  to  the 
priest,  and  on  which  pastoral  medicine  must  give  him 
information,  that  is : 

As  to  the  right  of  the  suicide  to  ecclesiastical  sepulture. 

A  suicide  cannot  be  denied  ecclesiastical  interment, 
when  his  insanity  has  been  clearly  developed  and  known  as 
such,  unless,  of  course,  the  refusal  is  based  on  other  reasons 
existing  before  the  beginning  of  insanity. 


HYPOCHONDRIASIS.  61 

« 

But  how  about  the  opinion  which  pronounces  every 
suicide  to  be  insane  at  the  moment  of  his  deed,  and  which 
claims  ecclesiastical  interment  for  all  of  them  on  this 
ground  ?     Is  there  no  suicide  without  insanity  ? 

The  doctrine  of  monomania  asserted  the  existence  of  a 
suicidal  monomania  without  insane  delusion ;  and  taught 
that  such  lunatics  committed  this  deed  under  the  influence 
of  impulses  over  which  they  had  no  control.  But  science 
has  thrown  more  light  on  this  and  other  monomanias,  and 
has  shaken  the  belief  in  uncontrollable  impulse.  The 
most  important  point,  when  judging  the  responsibility  for 
a  deed,  is  always  the  motive  for  committing  it.  Therefore 
we  have  to  ask  in  what  the  uncontrollable  impulse  had  its 
foundation  in  each  case. 

In  practice,  the  following  may  be  maintained.  Can  a 
probable  cause  be  found  for  the  mental  depression  leading 
to  suicide,  such  as  defamation,  loss  of  fortune,  of  relatives  ; 
local  lesions,  disappointment,  an  excited  state  of  any 
passion,  fast  living,  excessive  extravagance,  or  vices,  and 
the  like?  The  priest,  in  such  cases,  would  be  justified  in 
refusing  ecclesiastical  burial,  unless  a  morbid  psychical 
condition  could  be  proved  besides.  Without  the  morbid 
condition,  an  emotion  or  psychical  depression,  produced  by 
such  causes,  cannot  be  regarded  as  the  source  of  an  irre- 
sistible impulse.  By  the  help  of  religion,  of  faith  in  God, 
of  belief  in  the  immortality  of  the  soul  and  of  an  eternal 
retribution,  such  impulses  can,  and  must,  be  overcome.  If 
any  morbid  condition  exists,  this  emotion  or  depression  may 
have  such  an  intense  influence  that  a  derangement  of  the 
mind  becomes  real.  During  this  sudden,  and,  perhaps^  only 
momentary,  derangement,  the  impulse  encounters  no  re- 
sistance and  is  acted  upon.  Such  morbid  conditions  (be- 
sides the  mental  diseases  properly  so  called)  are  :  epilepsy, 


62  THE   FIFTH    COMMANDMENT. 

• 

hypochondriasis  and  hysteria,  lunacy  and  clairvoyance ; 
further,  a  melancholic,  gloomy  temperament ;  enthusiasm, 
especially  of  a  religious  sort,  accompanied  perhaps  by 
visions  and  hallucinations ;  excessive  susceptibility  and 
nervous  feebleness,  great  mental  weakness,  and  clearly 
developed  eccentricity  of  character: — this  circumstance 
may  be  very  important,  if  cases  of  mental  derangement 
can  be  pointed  out  as  having  occurred  in  the  family  of  the 
deceased.  Other  causes  are  the  following:  severe  injuries 
to  the  nervous  system,  particularly  from  injuries  to  the  head; 
pregnancy  and  the  puerperal  state  ;  some  severe  acute  and 
chronic  diseases  of  the  body,  such  as  :  malarial  fevers,  small- 
pox, erysipelas,  pneumonia,  acute  rheumatism ;  syphilis, 
tuberculosis,  diseases  of  the  heart,  diseases  (not  venereal) 
of  the  genital  organs,  particularly  in  the  female  sex. 

For  all  these  affections  are  such,  that  real  derangement 
of  the  mind  may  be  slowly  developed,  or  suddenly  make 
itself  felt,  after  a  profound  emotional  excitement.  When 
any  one  of  these  affections  has  shown  itself,  the  axiom,  ^^  in 
dubiopro  reo,^^  should  be  followed,  and  mental  derangement, 
clouding  of  the  intellect  at  the  moment  of  the  act,  may  be 
assumed,  and  ecclesiastical  burial  granted. 

The  cases  that  now  remain  are  those  wherein,  after  care- 
ful inquiry  and  examination,  neither  one  of  the  rational 
causes,  before  enumerated,  of  an  excessive  emotion  or 
depression  can  be  discovered,  nor  one  of  the  morbid  con- 
ditions,— cases  wherein  men  sound  in  body  and  mind,  who 
have  not  the  least  rational  cause  to  be  tired  of  life,  suddenly 
become  suicides.  There  remain,  then,  two  things  possible. 
Either  there  existed  one  of  the  rational  causes  of  psychical 
alteration;  or  the  deed  was  nevertheless  done  in  consequence 
of  a  morbid  condition  which  was  not  recognized,  and  thus 
in  a  state  of  momentary  irresponsibility.     A  third  possi- 


HYPOCHONDRIASIS.  63 

bility  *  does  not  exist ;  for,  a  man  who.  without  a  motive 
of  weighty  import,  commits  an  act  that  is  of  so  momentous 
a  character,  and  so  contrary  to  human  nature  and  to  reason, 
must  be  presumed  to  have  been  clouded  in  his  intellect  at 
the  moment  of  the  act.  It  must  be  kept  in  view  that  it 
is  always  a  possible  thing  that  derangements  of  the  organ- 
ism may  speedily,  nay,  on  a  sudden,  take  place,  and  among 
them  such  as  cause  mental  derangement.  It  is  clear  that 
a  man  laboring  under  such  a  defect  of  his  reason  may  be 
tempted  to  do  things  which,  up  to  the  time,  he  had  not  so 
much  as  dreamed  of  doing,  and  even  abominated.  Well- 
marked  cases  of  sudden  and  unexpected  developments  of 
insanity  (without  suicide)  have  positively  come  under  ob- 
servation, although  it  cannot  be  denied  that  their  occurrence 
has  been  rare.  But  just  as  rare  are  the  cases  of  suicide 
that  have  not  sprung  from  motives  of  the  one  or  the  other 
class.  The  question  is,  whether  ecclesiastical  burial  may 
be  granted  in  these  cases.  Scavini  (1.  c,  tom.  iii,  pag.  90) 
says  no  :  '^  Nam  opus  externum  semper  praesumitur  volun- 
tarie  positum,  nisi  cerio  oppositum  constet.'^^  I,  for  my  part, 
am  inclined  to  answer  in  the  affirmative.  The  axiom,  in 
dubio  pro  reo^  should  be  applied  here ;  the  more  so,  as  the 
punishment  of  an  act  which  may  not  have  been  guilty,  and 
the  shame,  if  the  burial  is  refused,  strike,  not  the 
suicide  alone,  but  his  surviving  relatives.  Such  a  catas- 
trophe coming  unexpectedly,  and  from  no  apparent  motive, 
proves  to  them  a  source  of  terror  and  pain,  that  may 
increase  to  horror.  Why  expose  them  to  this  shame,  when 
there  is  no  certainty  that  it  is  merited  ?  The  reason  quoted 
by  Scavini  may  contain  an  axiom  that  is  correct  in  general, 

*  As  a  third  possible  thing,  one  could  quote  tentatio  diaholica  as  a  direct 
cause  of  suicide.  But  this  is  not  to  the  point  liere,  because  it  cannot  be 
proved,  and  must  therefore  be  regarded  ia  the  same  light  as  au  unrecognized 
cause  of  psychical  alteration. 


64  THE   FIFTH    COMMANDMENT. 

but,  with  regard  to  the  point  in  question,  I  had  rather  not 
accept  it  for  the  reasons  given. 

In  the  event  of  a  case  of  the  kind  occurring,  the  best 
course  for  the  priest  to  pursue  would  be  to  demand  the 
opinion  of  the  physician,  with  the  reasons  stated  Yfhioh  admit 
of  a  presumption  of  mental  derangement  at  the  moment  of 
suicide.  In  the  event  of  his  believing,  according  to  the 
principles  sketched  above,  that  the  presumption  of  mental 
derangement  is  not  sufficiently  founded,  pastoral  theology 
must  instruct  him  what  he  has  to  do. 


MENTAL  DISEASES. 

Priests  are  quite  often  asked  to  assist  in  the  treatment 
of  insane  persons,  because  non-medical  men  do  not  believe 
in  treating  mental  diseases  from  a  purely  somatological 
standpoint ;  but  are  disposed  to  prefer  a  psychological  or 
religious  treatment.  For  the  same  reason,  the  advice  of  a 
priest  is  often  invoked  before  the  physician  is  sent  for, 
especially  in  the  first  stages  of  mental  derangement.  In 
the  latter  case,  it  would  be  the  priest's  duty  to  insist  on 
sending  for  a  physician,  because  there  is  no  reasonable 
doubt  that  each  disorder  of  the  mind  is  caused  by,  or  at 
least  connected  with,  disorders  of  the  body.  The  physi- 
cian is  alone,  of  course,  competent  to  discover  and  judge 
correctly  of  them,  and  to  trace  their  connection  with  the 
mental  derangement. 

How  may  the  priest  render  good  service  in  treating 
insane  persons  f 

He  can  and  should,  at  all  times  and  places,  oppose  the 
popular  prejudice  of  mental  derangements  being  disgraceful 
in  themselves,  or  anything  else  than  diseases.     Although, 


MENTAL   DISEASES.  65 

among  the  causes  of  the  mental  derangement,  there  may  be 
sucli  as  render  men  despicable,  yet  the  insane  are  nothing 
else  than  sufferers  from  disease,  and  deserve  as  much  pity 
as,  yea,  a  hundred-fold  more  than,  those  suffering  from  mere 
bodily  disorders.  Mental  disease  is  a  sad  affliction  to  the 
patient  and  to  his  family  and  to  all  around  him  ;  but  much 
more  sad  is  the  prejudice  against  these  unfortunate 
sufferers.  The  family  of  which  these  poor  unfortunates  are 
members,  will,  with  a  painful  earnestness,  hide  their 
condition,  and  often  deprive  them  unnecessarily  of  the 
freedom  they  should  have.  Up  to  this  very  day,  the  insane 
are  locked  up,  mocked,  laughed  at  and  derided,  even  ill- 
treated.  Very  many  people  within  our  own  '^  enlightened  " 
century  act  as  though  the  sufferer  from  disease  and  de- 
rangement of  the  mind  were  an  outcast  from  human  society. 
The  very  family  of  the  patient,  every  member  of  which 
would  be  eager  to  nurse  any  of  its  members  suffering  from 
bodily  disease  with  tenderest  care,  and  to  give  every 
attention  to  alleviate  the  pains  and  sufferings,  and  to 
provide  for  the  necessities  and  wishes,  of  the  sick,  turns 
away  its  very  sympathies  from  any  one  of  its  members 
who  may  become  afflicted  with  mental  disease.  The 
irrational  doings  of  the  diseased  person  are  considered  as 
mere  vagaries,  or  as  wilful,  mischievous  perversions ; 
mockery  and  punishment  are  made  use  of.  Any  melan- 
choly distempers  are  looked  upon  as  unnecessary  moodings, 
and  unfounded,  self-torturing  discontent.  The  already 
over-sensitive  patient  is  driven  to  amusements,  is  forced 
into  society,  to  travel,  to  go  to  watering-places  ;  no  heed  is 
taken  of  the  fact  that  his  condition  requires,  above  all,  rest. 
In  short,  to  misunderstand  the  condition  of  the  insane 
patient  is  the  order  of  the  day.  In  this  respect,  the  priest, 
when  called  in,  can  render  good  service,  by  recognizing 


6Q  THE   FIFTH    COMMAXDMENT. 

the  patient  as  really  ^^  sick,"  and  by  requiring  that  a 
physician  be  sent  for.  From  this  time  forward  the 
treatment  of  the  case  must  be  left  exclusively  in  his  hands. 
His  directions  must  be  implicitly  obeyed  alike  by  priest  and 
family.  For,  in  mental  diseases,  the  slightest  neglect  may 
render  a  cure  impossible.  The  application  of  litting  reme- 
dies, at  the  first  appearance  of  symptoms  of  mental  de- 
rangement, is  of  an  importance  not  to  be  overestimated. 

Many  unfortunate  creatures  at  present  suffering  from 
aberration  of  intellect,  without  hope  of  cure,  might  now  be 
in  possession  of  their  reason,  if  they  had  been  treated 
correctly  at  the  period  named.  It  is  the  experience  of 
all  asylums  that  the  patients  are  commonly  brought  in  too 
late  ;  and  that,  during  the  interval  between  the  commence- 
ment of  the  disorder  and  the  admittance  of  the  patients^ 
they  had  received  neither  help  nor  consolation,  but  in- 
jurious treatment.  For  these  reasons,  I  advise  that  insane 
people  be  taken  to  asylums  as  soon  as  possible. 

As  to  the  necessity  or  policy  of  placing  a  patient  in  an 
asylum  immediately  after  the  commencement  of  his  disease, 
the  question  cannot  be  discussed  here.  In  every  case 
the  physician  will  have  to  be  the  judge.  Should  the 
physician,  however,  decide  that  the  restraint  of  an  asylum 
is  necessary,  then  a  second  prejudice  manifests  itself,  to 
wit,  an  aversion  on  the  part  of  the  public  mind,  educated 
as  well  as  uneducated,  to  institutions  of  this  kind.  This 
aversion  has  its  origin,  for  the  most  part,  in  a  mistaken 
estimate  of  mental  diseases,  and  a  morbid  dread  of  public 
opinion.  It  is  increased  by  natural  love,  which  now 
asserts  itself  with  renewed  energy.  The  unfortunate 
relative  may  have  been  derided,  abused,  and  even  ill- 
treated,  by  his  own  family,  but  to  the  asylum  he  must 
not    go.     And  why  ?     Because,  we  are  answered,  these 


ME^^TAL   DISEASES.  67 

asylums  are  worse  than  jails ;  because  diet  and  lodging, 
attendance  and  treatment,  are  bad;  because  the  attend- 
ants use  force  toward  the  patient,  maltreat  him,  and  so 
on.  Whether  it  be  egotism  or  love  which  causes  this 
aversion  to  placing  the  patient  in  an  asylum,  he  is  the 
sufferer  from  this  way  of  acting.  Here,  again,  the  priest, 
whose  counsel  is  often  asked  in  such  matters,  may  render 
good  service,  by  explaining  to  the  relatives  how  they  may 
best  show  their  affection  for  the  unfortunate  one  ;  by  urging 
them  not  to  stand  in  the  way  of  the  cure  of  this  terrible 
affliction  by  delay  or  through  want  of  common-sense  ;  and 
by  informing  them  that  they  are  bound  in  conscience,  if  the 
physician  declares  the  placing  of  the  patient  in  an  asylum 
to  be  necessary,  to  act  according  to  his  directions,  even 
against  the  will  of  the  patient.  The  patient  himself  cannot 
say  what  is  baneful  or  beneficial  in  his  case  ;  and  his  family 
are  compelled  to  act  for  him,  even  against  his  own  wrong 
judgment,  and  against  his  morbidly  perverted  will. 

Direct  psychical  treatment  of  the  patient  by  the  priest 
must  be  regulated  according  to  the  directions  of  the 
physician.  It  may  be  remarked  that  such  treatmsnt  is 
generally  of  no  use,  and  is  often  hurtful.  Priests  will,  of 
course,  naturally  betake  themselves  to  the  use  of  religious 
reasoning;  but  the  patient  will,  very  probably,  regard 
with  suspicion  this  ^^  religious  influence."  In  general,  the 
priest  is  not  in  such  cases  the  proper  person  for  psychical 
treatment.  Even  in  the  case  of  the  patient  wishing  to 
consult  him, — it  may  be  about  insane  scruples, — the  utmost 
care  and  discretion  will  be  needed.  If  you  reason  a 
melancholy,  scrupulous  patient  out  of  one  of  his  scruples, 
a  dozen  others  will  present  themselves  to  torture  him. 
All  possible  arguments  of  reason,  religion,  and  philosophy, 
may  be  brought  for^\  ard :  as  well  try  to  fill  a  sieve  with 


68  THE   FIFTH    C03IMAXDMENT. 

water.  The  patient  must  have  recovered  the  healthy 
exercise  of  his  reason  before  religious  treatment  can  be 
of  any  service  to  him. 

It  may  be  remarked,  in  general,  that,  in  treating  the 
delusions  of  an  insane  patient,  two  extremes  must  be  alike 
avoided — that,  namely,  of  assenting  to  them  unreservedly, 
and  that  of  contradicting  them  with  persistent  harshness. 
Assent  confirms  the  false  ground  the  patient  has  taken  ; 
contradiction  angers,  nay,  exasperates  him.  Such  de- 
lusions, and  whatever  may  lead  to  them,  should  rather  be 
avoided ;  the  patient's  attention  should  be  drawn  to  some- 
thing else ;  other  objects  should  be  placed  before  his 
mind,  which  is  perverted  in  one  direction.  But,  in  doing 
this,  every  possible  care  should  be  taken  to  avoid  dishon- 
esty in  dealing  with  the  patient,  as  well  as  every  kind  of 
deception  or  trickery.  For,  distrust  and  exasperation 
against  individuals  or  the  world  at  large,  arising  from 
such  wrong  practice,  are  often  the  greatest  hindrance  to 
a  successful  cure,  even  when  the  patient  has  been  placed 
in  an  asylum.  For  the  same  reason,  the  patient  should 
not  be  inveigled  into  an  asylum,  under  any  pretext  or 
deceit.  Excitement,  lasting  for  days  and  weeks,  of 
patients  that  have  been  quiet  enough  before,  is  the  conse- 
quence of  such  practices,  as  every  physician  of  the  insane 
knows. 


B— THE  SIXTH  C0MMA:NDMENT. 

The  sins  against  this  commandment,  peccata  luxuriae, 
surpass  in  our  times,  and  probably  always  have  surpassed, 
both  in  number  and  in  kind,  sins  committed  against  all  the 
other  commandments  put  together.  This  lamentable  fact 
has  its  explanation  in  the  fall  of  human  nature.  Upon 
this  subject,  consequently,  the  priest  feels,  in  an  especial 
manner,  the  necessity  of  being  possessed  of  every  possible 
information  which  may  guide  him  in  the  discharge  of  his 
duties  in  regard  to  it.  For,  not  only  are  these  sins  of 
lamentably  fi'equent  occurrence,  and  of  the  greatest  annoy- 
ance to  him  in  exercising  his  duties  as  confessor,  but,  also, 
they,  more  than  others,  affect  the  human  body,  and  stand 
in  close  relationship  wiLh  the  most  important  function  of 
the  human  organism. 

The  question  has  often  been  agitated  whether  or  not 
such  dangerous,  as  well  obscene,  matter  should  not  rather 
be  treated  of  in  the  Latin  language.  I  agree  with  those 
who  prefer  the  vernacular.  As  to  the  danger  of  unpro- 
fessional persons  reading  such  matter  for  the  gratification 
of  a  prurient  nastiness,  it  is  certain  they  need  not  have 
recourse  to  a  work  on  pastoral  medicine,  or  to  any  other 
scientific  work,  for  such  an  object,  inasmuch  as  they  may 
find  abundant  occasion  of  gratifying  their  lust  in  the  bad 
literature  of  the  day.  As  to  obscenity,  I  say  witli 
Debreyne,*  that  the  use  of  the  vernacular  ^'  loin  cV avoir  de 
V inconvenient,  n'ohlige  qtt^a  une  plus  grande  circonspedion 

*  L.  C,  preface. 


70  THE   SIXTH   COMMANDMENT 

dans  le  langage  et  a  une  plus  grande  decence  dans  Texpres- 
sionj  tandis  qu^ordmairemcntj  a  la  faveur  dhm  plat  latin j  on 
se  croit  en  droit  de  tout  dire,  et  de  dire  ce  que  souvent  on 
devrait  taireJ^ 

Besides,  I  should  have  found  great  difficulty  in  ex- 
pressing myself  in  Latin,  not  only  to  the  point  and  with 
accuracy,  but,  likewise,  in  finding  always  the  right  word  in 
which  to  convey  my  meaning ;  because  many  terms  that 
are  used  by  the  medical  men  of  science  of  our  days  can 
scarcely  be  expressed  in  the  Latinity  common  and  in 
vogue  amongst  us,  and  new-coined  words  would  have 
derogated  from  the  clear  meaning  of  the  text.  Neverthe- 
less, I  have  tried  to  respect  both  opinions  by  using  many 
terms  only  in  Latin. 


I.— MASTURBATION. 

This  murderous  vice  is  to-day  fearfully  common,  ac- 
cording to  the  testimony  of  both  priests  and  physicians. 
It  leads  to  consequences  most  injurious,  and  its  cure  is 
extremely  difficult. 

Besides  the  contagion  of  bad  example,  in  the  school, 
during  gymnastic  exercises,  bathing,  sleeping  together  in 
the  same  bed,  the  following  causes  of  self-abuse  must  be 
particularly  named  :  evil-minded  domestics  ;  servant-girls 
who  tickle  the  sexual  parts  of  little  children  in  order  to 
quiet  them  ;  effeminate  education  ;  sedentary  studies  which 
do  not  really  occupy  the  mind,  and  are  not  accompanied 
by  proper  bodily  exercise ;  the  enervating  sentimental, 
and  indeed  licentious,  literature  of  the  day,  together  with 
its  manifold  immoral  art-representations  5  the  want  of 
modesty,    nay,    the    downright    immorality,  existing     at 


MASTURBATION.  71 

tlieatres  and  balls,  to  which  young  people  gain  a  sadly 
early  admittance.  Sometimes  pathological  affections  of 
the  genital  organs,  such  as  pustules,  itching  caused  by 
small  worms  or  by  uncleanliness,  may  directly  lead  to  this 
vice  J  and  such  cases,  which  generally  affect  younger  chil- 
dren, become  less  known  to  priests  than  to  parents.  They 
should  invariably  be  referred  to  the  physician. 

The  vice  is  most  common  with  boys  and  youths,  but  it 
cannot  be  denied  that  it  is  prevalent  even  amongst  young 
people  of  the  other  sex.  These  unfortunate  creatures  of 
both  sexes,  with  languishing,  confused,  and  timid  glances  j 
sunken  and  blue-encircled  eyes,  their  faces  pale,  puffed, 
and  wan ;  their  hands  perspiring,  and  flabbily  hanging 
down ;  their  knees  weak  and  easily  bending  ;  with  such 
wretched  carriage  and  constant  inclination  to  sit  or  lean 
against  some  support, — these  stupid  beings  of  thoughtless, 
absent,  morose  disposition,  we  meet,  alas !  too  often. 
They  hide  away  in  any  retirement,  become  timid,  full  of 
apprehension,  dislike  the  joyous  pleasures  of  youth,  and 
anything  like  serious  mental  activity,  lie  in  bed  of  a 
morning,  and  become  emaciated  and  stunted  in  their 
development.  Later  on,  they  are  affected  with  involuntary 
passive  pollutions,*  with  frequent  swoonings,  tremblings, 
and  palpitations  of  the  heart.  Finally,  the  vice  is  attended 
with  incurable  conditions  of  general  decline,  of  dropsy, 
epilepsy,  and,  in  some  cases,  with  spinal  consumption. 
In  the  female  sex,  it  becomes  the  occasion  of  various 
disorders  of  the  womb,  and  of  hysteria.  Add  to  the 
above,  the  tortures  of  remorse,  and  fear  of  the  consequences, 
physical  as  well  as  moral,  of  these  practices  which  they 
cannot  leave   off.     Thus   these   unfortunates  become,  not 

*  See  farther  on,  under  "'  Pollutions." 


72  THE   SIXTH   COMMANDMENT. 

unfrequently,  melancholy,  and,  at  last,  mad.  Their  depres- 
sion of  spirits  becomes  intolerable,  and  often  their  lives 
end  in  suicide. 

Such,  in  general,  is  a  picture  of  these  unfortunates,  who 
are  by  habit  addicted  to  this  nefarious  practice.  But 
not  all  these  symptoms,  or  at  least  not  in  so  pronounced  a 
manner,  characterize  every  case.  Some  persons  have 
their  nervous  system  shattered  in  a  less  degree,  although 
they  may  have  practised  self-abuse  for  many  years.  And, 
on  this  account,  it  is  not  wise  to  depict  the  consequences 
of  this  vice  in  too  vivid  colors,  lest  the  sinner  may  give 
the  lie  to  his  monitor.  There  is  another  reason  which 
renders  it  desirable  to  exercise  great  care  in  cautioning 
young  people  against  this  evil.  It  is,  that  many  an  un- 
fortunate to  whom  our  cautions  are  addressed  may  be 
already  a  prey  to  depression  of  spirits,  partly  in  con- 
sequence of  the  weakening  of  the  nervous  system,  partly  in 
consequence  of  remorse  and  shame ;  and  again  the  genital 
organs  become,  from  frequent  and  unnatural  excitement, 
morbidly  sensitive, — so  much  so,  that  the  depressed  mind 
and  enervated  will  are  not  equal  to  the  subduing  of  the 
bodily  desires.  The  corrupted  imagination,  filled  with 
voluptuous  pictures,  scarcely  admits  of  any  other  interest, 
and  it  requires,  if  the  evil  has  made  any  progress,  very 
severe  struggles  to  abandon  this  vicious  habit ;  indeed, 
without  higher  religious  motives,  such  men  are  seldom 
converted.  It  is  obvious  that  the  utmost  discretion  should 
be  used  in  endeavoring  to  dissuade  men  in  such  a  condi- 
tion from  this  pernicious  vice.  Earnest,  but,  at  the  same 
time,  kind  and  consoling  words,  calculated  to  sustain  the 
moral  strength,  will  best  answer  the  purpose.  Due  con- 
sideration must  be  given  both  to  the  existing  cause  and 
to  the  circumstances  exciting  to  this  sin,  and  a  rule  must 


MASTURBATION.  73 

be  laid  down  in  accordance  with  them.  Medical  treatment 
is  not  within  the  sphere  of  the  priest.  If  there  are  signs 
of  failing  health,  then  the  penitent  should  by  all  means  be 
referred  to  a  physician ;  indeed,  he  should  be  always 
counselled  to  take  medical  advice  about  the  manner  of 
living  best  suited  for  his  personal  condition,  in  order  to 
reduce  excitability,  and  to  support  his  moral  endeavors  to 
overcome  this  vice. 

Marriage  is,  of  course,  the  best  remedy.  This  is  one  of 
the  chief  reasons  why  so  comparatively  small  a  number 
of  those  addicted  to  this  vice  perish  from  the  evil  effects 
above  mentioned.  In  the  greater  number  of  cases,  mar- 
riage will  effect  a  cure.  It  may  happen  that  the  vice  of 
self-abuse  may  continue  even  after  marriage ;  but  it  is  the 
exception,  and,  in  most  cases,  there  are  special  reasons  to 
account  for  it.  The  natural  and  normal  conjugal  rela- 
tions are  best  suited  to  arouse  disgust  and  aversion  against 
this  unnatural  abuse.  The  priest,  as  well  as  the  physician, 
should  therefore  urge  those  persons  to  enter  as  soon  as 
possible  into  the  marriage  state,  if  circumstances  allow  it. 
A  fear,  generally  unfounded,  of  impotence  has  then  to  be 
overcome.  Through  fear  of  impotence  and  the  depression 
of  spirits  arising  from  it,  the  genital  organs  having  been 
weakened,  a  temporary  impotence  ad  copulain  may  exist, 
which  fact,  of  course,  increases  the  depression.  This  fear 
of  impotence  must  be  combated  as  soon  as  it  appears,  ■ 
generally  by  the  physician,  for  he  is  better  fitted  than  the 
priest  to  give  counsel  and  to  encourage  in  such  situations. 
But  terribly  vicious,  and,  thank  Grod !  of  rare  occurrence 
is  the  expedient  adopted  by  the  physician  of  sending  his 
timid  and  apprehensive  patient  to  the  prostitute  in  order  to 
test  his  potency.  A  like  abuse  of  trust  and  insult  to  mora  ity 
is  it  to  counsel  a  man  to  have  illicit  sexual  intercourse  in 

d 


74  THE    SIXTH    COMMANDMENT. 

order  to  be  cured  of  self-abuse,  when  he  cannot  at  the 
time  contract  a  marriage.  This  is  to  drive  out  Satan 
through  Beelzebub :  and  the  physician,  in  both  cases,  is 
accessory  to  grave  sins.  Yet  it  is  done,  although  rarely. 
As  I  remarked  before,  the  long-continued  practice  of 
self-abuse  leads  in  some  persons  to  very  alarming  nervous 
affections,  while  others  experience  the  evil  consequences 
in  a  less  degree.  It  is  necessary,  therefore,  to  be  on  one's 
guard  against  ha^ty  judgments,  when  connecting  cause  and 
effect  in  this  regard.  For,  from  the  above-described 
morbid  appearances,  the  presence  of  the  vice  of  self-abuse 
can  neither  always  be  inferred,  nor,  when  this  vice  and 
those  nervous  affections  are  really  present  at  the  same 
time,  can  we  always  regard  the  latter  as  resulting  from 
the  former.  The  contrary  is  often  the  case,  especially 
with  insane  and  hysterical  persons,  where  it  can  be  some- 
times proved,  when  connecting  cause  and  effect,  that  the 
disease  is  the  primary,  and  self-abuse  the  secondary,  evil. 
This  fact  will  be  of  little  practical  interest  to  the  priest  as 
regards  insane  people  ;  but,  in  cases  of  liysteria,  its  interest 
is  apparent.  Religious  enthusiasm  and  excessive  sexual 
excitability  often  accompany  one  another  in  such  cases, 
and  then  they  become  very  troublesome  to  the  priest. 
Such  patients  often  assert,  amongst  other  things,  that  tliey 
experience  relief  from  pain  ■  through  practising  self-abuse 
in  a  more  or  less  complete  way  (pressing  or  rubbing  of  the 
clitoris,  etc.).  It  may,  indeed,  appear  so  to  the  patient,  for 
pain  and  lust  meet  each  other,  and  may  alternate  in 
hysterical  persons,  whose  nervous  system  is  so  much  per- 
verted ;  but  this  can  never  make  ^oX^-almse  alloivahle  to 
these  patients.     These  practices,  as  resulting  from  a  morbid 

*  On  tactus  impudicus,  which  is  allowed  ad  scdandum  pruritum  sen 
dolorem, — see  farther  on. 


MASTURBATION.  75 

condition  of  the  body,  may  not  appear  sinful  to  them, 
but  they  are,  nevertheless,  materially,  an  unnatural  and 
illicit  gratification  of  the  sexual  instinct ;  and  the  danger 
of  consent  is  immediate,  for  frequent  repetitions  cannot 
be  avoided.  The  priest  cannot  alloiv  it  5  but,  should  he 
think  the  psychical  conditions  of  the  patient  changed  to 
such  a  degree  that  the  sin  cannot  be  imputed  to  her, 
then  she  is  only  so  far  responsible  as  she  may  have  been 
originally  guilty  of  causing  or  encouraging  her  abnormal 
condition;  and  her  case  no  longer  has  its  place  in  foro 
conscientiae,  but  must  be  subjected  to  the  treatment  of  the 
physician  of  the  insane,  and  must  invariably  be  referred 
to  him.  If  the  patient,  being  anywise  aware  of  the  sinful- 
ness of  this  practice,  or  expressing  doubts  about  it,  says 
she  could  not  refrain  on  account  of  the  pain  or  itching,  etc., 
then  she  must  be  instructed  with  regard  to  the  material 
sinfulness  of  her  actions,  and  forbidden  to  repeat  them, 
because  of  the  proximate  danger  of  consent ;  and  she  must 
be  told  to  seek  medical  help  in  her  morbid  condition. 
The  pretext  of  repugnance  to  medical  examination  and. 
consultation  should  not  be  easily  credited.  A  really  chaste 
woman  will  be  made  so  unhappy  through  the  condition 
above  described,  and  will  detest  the  desires  and  practices  of 
self-abuse  arising  therefrom  to  such  a  degree,  that  she 
certainly  will  not  refuse  a  decent  medical  consultation,  if 
she  is  told  that  she  may  entertain  a  well-grounded  hope  of 
being  in  this  way  freed  from  her  physical  affliction  and 
moral  danger. 

It  is  impossible  to  enumerate  here  all  the  different  kinds 
of  self-deceit,  and,  still  more  so,  to  follow  all  the  windings 
and  twistings  of  hysterical  persons.  One  example  may 
serve  to  illustrate  my  view  of  the  matter. 

A  hysterical  person,  of  good  morals  in  all  other  respects, 


■7G  THE    SIXTH    COJIMAXDMENT. 

confesses  that  she  touches  her  person  at  certain  times. 
She  relates  how  she  has  to  suffer  severe  pains  for  three 
long  days  at  the  beginning  of  her  periods,  staying  in  bed 
during  that  time ;  how  the  pain  is  severe  at  night-time, 
but  during  the  day  is  very  much  milder  j  liow  she  has 
consulted  many,  and,  among  them,  famous  physicians,  but 
to  no  purpose  j  that  she  has  found  (how  did  she  find  that  1) 
great  relief  from  pains  through  a  pressing  and  manipulating 
(of  the  clitoris  ?)  accompanied  by  voluptuous  sensations,  and 
that  she  has  therefore  made  a  practice  of  thus  handling 
herself. 

Can  the  father -confessor  allow  such  manipulations,  or 
must  he  prohibit  them  as  self-abuse  ? 

My  opinion  is  that  they  must  be  forbidden ;  for  there  is 
no  reason  why  this  hysterical  person  may  do  anything  in 
itself  forbidden,  in  order  to  relieve  her  pains.  That  she  is 
well  aware  of  the  material  sinfulness  of  her  practice,  is 
evident  from  the  fact  that  she  accuses  herself.  Besides, 
her  story  is  rendered  very  improbable  with  regard  to 
physiological  facts,  at  least  to  men  of  sound  judgment.  The 
pains  of  menstruation  are  caused  for  the  most  part,  and 
probably  exclusively,  by  a  greater  determination  of  blood 
to  the  internal  sexual  organs,  which  can  be  only  increased 
momentarily  by  the  irritation  of  the  external  parts.  Now, 
we  may  easily  believe  that  such  increased  rush  of  blood 
will  make  menstruation  set  in,  and  thus  take  away  the 
pains :  but  why  do  they  cease  during  the  daytime  and 
return  at  night,  to  be  rendered  less  severe  through  these 
self-abusing  practices  ?  As  far  as  I  can  see,  there  is  only 
one  probable  explanation  of  this.  A  greater  determination 
of  blood  toward  the  genital  organs  at  the  monthly  periods 
causes,  in  addition  to  the  pain  (f)  that  may  result  from  it,  an 
exalted  sexual  excitement,  the  nerves  of  the  person  being 


MASTURBATION.  77 

in  so  irritable  a  condition.  These  feelings  become  mixed 
up,  and  cause  her  to  gratify  that  impulse.  May  be,  under 
the  influence  of  the  subsequent  relaxation,  the  feeling  of 
pain  becomes  less  intense,  and  thus  the  patient  persuades 
herself  that  she  is  acting,  not  in  order  to  gratify  any 
sexual  excitement,  but  to  relieve  her  pain.  During  the 
daytime  she  has  less  opportunity  of  doing  so  unnoticed,  or 
perhaps  other  affairs  draw  her  attention  from  her  abnormal 
feelings  :  her  cure  is  effected,  therefore,  only  at  night. 

Responsibility  supposed,  and  all  by-intentions  excluded, 
does  this  intention  of  relieving  pain,  even  excruciating  pain, 
justify  the  practice  of  masturbation,  which  in  itself  is 
forbidden  ?  A  distinction  must  certainly  be  made  between 
that  tadus  impudicus  that  causes  per  accidens  a  pollution, 
and  between  masturbation,  i.  e.,  that  tadus  impudicus  which 
is  apt  to  induce  pollution  directly.  In  the  case  of  men, 
there  is  scarcely  any  doubt  in  this  matter.  The  tadus 
impudicus  ad  dolorem  seu  pruritum  sedandmn  is  certainly 
allowed  to  them,  even  should  pollution  follow  as  an  accident. 
But  to  cause  pollution  is  forbidden  in  itself,  and  tliose 
tadus  impudici  cannot  therefore  be  allowed  which  directly 
bring  it  on.  Thus,  c.  g.,  scratching  on  the  parts,  rubbing 
of  the  skin  of  the  scrotum  or  its  adjoining  parts,  is  not 
forbidden,  because  this  ca^uses  pollution  only  per  accidens. 
But  by  rubbing,  ad  pruritum,  sedandum,  the  penis,  or  the 
glans  penis,  the  individual  would  stir  the  immediate  cause 
oi  SiXi  erectio  d  pollutiOj  would  directly  excite  the  voluptas 
carneaj  and  put  himself  in  danger,  which  is  in  its  nature 
nearly  unconquerable,  of  consenting  to  pollution.  Besides, 
in  this  case,  sedatio  pruritus  would  be  effected  only  after 
the  nervous  excitation  had  been  lessened,  and  the  irritability 
assuaged,  through  solution  of  the  material  voluptas  venerea 
and  of  pollution.     Therefore  moralists  forbid  to  men,  with- 


/O  THE    SIXTH    COMMANDMENT. 

out  condition,  that  is,  absolutely,  any  such  touches  as  lead 
to  masturbation — declaring  that  pollution  is  a  forbidden 
thing. 

In  the  case  of  females,  there  is  no  pollution,  as  the  mor- 
alists have  it,  "  quia  verum  semen  in  midierihus  non  datura  * 
Masturbation  in  females  is  placed  by  the  moralists  under 
the  head  of  "  tactus  mipudicits.^^i  Eegarding  its  sinfulness, 
they  say  :  '^  Non  peccant  per  se  qui  se  tanguni  (sc.  impudice) 
ad  priiritimi  sedanduni,''^  %  But  tactus  impudici  are  forbid- 
den, ^^  etiam  secluso  affectu  venereo,  oh  gravem  indeceniiam 
et  imminens  libidinis  periculumy  Do  these  words  apply  to 
the  matter  we  have  here  under  consideration  ?  The  danger 
more  or  less  proximate,  or  more  or  less  remote,  of  libido,  of 
delectaiio  carnea,  caused  by  tactus  ad  pruritum  sedandum, 
can  by  no  means  be  placed  side  by  side  with  the  effects  of 
those  self-touchings  above  alluded  to.  Those  latter  are 
directly,  and  in  themselveSj  inclined,  not  only  to  the  causing 
of  a  delectation  not  at  first  intended,  but  to  the  effecting 
certainly  the  gratification  of  a  real  and  complete  sexual 
feeling,  because  they  affect  that  part  of  the  genitals,  which 
is,  in  fact,  the  principal  seat  of  sexual  sensation,  physio- 
logically speaking.  The  like  may  be  said  of  manipulations 
made  in  order  to  reach  and  excite  the  vagina  and  the 
uterus  {ope  digitorum  vel  aliorum  itistrumentoruin),  because 
they  are  likewise  directly  adapted,  though  in  a  less  degree, 
to  bring  on  a  sexual  feeling."^ 

*  The  distinction  made  by  Debreyne,  I.  c,  pag.  149  ff.,  in  females,  between 
ft  masturbation  accompanied  by  an  eifusion  external  or  internal,  and  a 
"simple  orgastne  ou  dcs  moiivenients  qu'on  apelle  dere(jles,  lesquels.  s'ils  ne 
iont  suivis  de  pollution,  s'epaisent  pen  d,  peu  sans  sensation  extraordinaire,^' 
is  in  itself  wrong,  and  in  tlie  end  to  no  purpose,  fur  lliere  is  never  effusion 
of  semen  ver,um,  and  therefore  no  pollution  in  the  s^nse  of  the  moralists. 
But  voluptas  venerea  may  exist  even  toself-gralitication,  without  any  effusion. 

f  Gur}',  1   c,  tom.  i,  pag.  418 — note.  i  Ibidem,  pag.  409. 

^  Debreyne  (1.  c.)  would  have  the  uterine  masturbation,  as  he  terms  seTf- 
ftbu?e,  practised  by  irritation  of  the  uterus,  to  be  regarded  as  a  more  grave 


MASTURBATIOX.  79 

I  find  what  is  of  the  essence  bf  masturbation  in  this 
voluptas  venerea  caused  by  manipulations  of  the  clitoris, 
vagina,  uterus,  or  of  all  these  parts  together.  In  an 
article  of  the  Noiivelle  Beviie  Theologique  '^  de  poUutione 
feminea,^^  A.  Eschbach,  Super ieiir  clu  seminaire  frangais 
de  Borne,  also  very  positively  points  out  *'  illlcita  delectatio 
venerea,''^  and  not  '^fnistratio  seminis,^^  as  of  the  essence 
of  masturbation  (pollution  according  to  the  moralists). 
Both  circumstances  make  up  the  malice  of  pollution,  pr^'- 
mario  vero  et  prineipaliter  polliitio  fit  peccatum  ex  delectaiione 
illlcita^  '^  ita  ut  si  Creator  Deus  generationis  organa  ita  dls- 
posuisset,  id  perinde  ac  in  scxu  sequiori  (pvula,  sc),  ita  etiam 
apud  virum  superfluum  semen  vel  nocivum  absque  lihidine 
efflueretj  liceret  utiqiie  procurare  hujusmodi  fluxum  ad  scr- 
vandam  vitam  vel  sanitatem  .  .  .  quare  etiamsi  in  poUutione 
nidla  haberetur  seminis  frustration  uti  apud  senes  obtinet, 
idem  specie  peccatum  foret.'''' 

From  this  standpoint,  a  distinction  between  masturbation 
in  men  and  in  women  cannot  be  sustained  any  more ;  and 
self-abusing  touches  (that  is,  manipulations  that  are  di- 
rectly and  in  themselves  adapted  to  cause  the  sexual  feeling) 
are  forbidden  in  the  same  degree  to  both  sexes.  But  the 
difference  in  species  between  what  is  commonly  termed 
(actus  impudicus  and  masturbation  in  females  is  striking, 
and  renders  it  clear  that  masturbation  cannot  be  allowable 
in  females  ad  pruritum  seu  dolorem  sedandum. 

Of  other  forms  of  unnatural  lust,  I  will  not  here  speak. 
Their  consequences   are  similar  to  those   resulting  from 

fonii  of  masturbation,  for  the  reason  that  the  fi-equent  violent  irritation  of 
the  uterus  is  in  itself  adapted  to  produce  sterility.  It  cannot  be  denied 
that  inflammations,  ulcers,  even  cancer,  and,  through  these,  sterility,  may, 
and  often  do,  arise  from  such  injurious  irritations  of  tiie  uterus.  But  whether 
this  circumstance  alters  the  species  peccati  seems  to  me  doubtful.  The 
masturbation  clitoridienne  (Debreyne)  also  shatters  the  whole  organism, 
genitals  included,  and  is  thus  often  the  cause  of  bringing  ou  sterility. 


80  THE    SIXTH    COMMANDMENT. 

ordinary  self-abuse.  I  will  only  mention  that  pederasty- 
is  of  more  frequent  practice  than  some  are  willing  to 
admit.  Although  in  the  days  of  paganism  even  philosophers 
were  guilty  of  this  vice^  yet  it  has  been  reserved  to  our 
century  to  make  an  attempt  at  justifying  it  from  a  moral- 
scientific  standpoint,  and  to  insult  society  with  the  claim 
that  it  is  entirely  allowable,  right,  proper  and  lawful.  A 
certain  Karl  H.  Ulrich  has  dared  to  maintain  such  a  pro- 
position in  his  writings,  the  last  of  which  was  published 
1868.  This  man  asserts,  in  the  introduction  to  one  of  his 
works,  that  about  twenty-five  thousand  pederasts  live  in 
the  German,  and  twenty  five  to  twenty-eight  thousand,  in 
the  Austrio-Hungarian,  Empire  :  the  numbers,  he  asserts, 
he  can  show  from  the  correspondence  of  these  unfortunate 
people.  If  this  be  correct,  then  it  is  horrible  indeed  :  for 
how  many  victims  of  their  beastly  lust  will  be  ruined  by 
these  vampires  ! 

During  the  last  year  a  book  was  published  in  Berlin 
which  attempts  to  found  a  system  of  absolute  sexual 
liberty,  from  the  standpoint  of  the  now  prevalent  philo- 
sophy of  materialistic  infidelity.  There  should  be  only 
such  restrictions  of  sexual  intercourse  as:  that,  outside  of 
marriage,  no  generating  of  children  should  be  allowed, 
and  sexual  intercourse  between  brothers  and  sisters  should 
not  be  of  too  frequent  occurrence,  lest  too  many  marriages 
between  brothers  and  sisters  be  contracted,  and  the 
population  be  thereby  increased  too  much.  In  other 
respects,  as  to  selection  of  persons,  and  as  to  time,  and 
place,  and  manner  (even  masturbation  and  sodomy), 
sexual  intercourse  should  be  ahsolutelp  without  restrictions. 
Finally,  the  author  of  the  filthy  production  urges  his 
readers  to  clear  the  road  for  this  "  commonwealth  of  free 
sexual  commerce  "  by  the  propagation  of  writings  which 


POLLUTIONS.  81 

advocate  it,  and  by  tlie  practice  (at  first,  in  small  circles) 
of  his  horrible  maxims. 


II.— POLLUTIONS. 

Pollution  {effush  seminis)  is  a  physiological  phenomenon 
in  all  male  persons,  occurring  with  or  without  cause, 
internal  or  external,  proximate  or  remote,  occasioned  by 
the  individual.  It  finds  its  cause  apart  from  internal  or 
external  sexual  excitement  in  the  irritation  of  the  seminal 
vesicles  through  the  semen.  The  more  irritable  the 
seminal  vesicles  are,  the  more  frequent  and  the  more  easy  is 
the  accident  of  pollution.  Persons  of  a  sanguine  tempera- 
ment, possessing  a  very  strong  plethoric  constitution,  are 
most  likely  to  suffer  pollutions,  especially  if  they  lead  a 
life  of  luxury.  Again  persons,  whose  nervous  system 
sufi'ers  from  excessive  sensibility,  or  whose  genital  system 
has  been  weakened  by  previous  excesses,  and  left  in  a 
state  of  morbid  irritation.  With  the  former,  pollution 
occurs  generally  only  during  sleep ;  with  irritable  persons 
it  also  occurs  when  awake ;  with  those  whose  organs  have 
been  weakened  by  excesses,  especially  in  the  form  of  long- 
continued  self-abuse,  it  generally  occurs  when  awake. 

Physiologically,  pollution  in  healthy  men  occurs  at  regu- 
lar intervals,  and  always  during  sleep.  The  intervals  are 
different,  extending  from  eight  days  to  several  months, 
according  to  the  constitution  and  habit  of  life.  These 
pollutions  are  not  hurtful  to  health,  and  certainly  are 
without  sin,  because  occurring  during  sleep.* 

*  Of  course  we  here  place  the  condition  that  no  sensual  imaginings,  read- 
ings or  conversations,  or  other  wilful  causes  before  going  to  sleep,  incite  to 
pollution. 


82  THE    SIXTH    COMMANDMENT. 

But  how  act  in  case  one  awakes  and  becomes  aware 
that  an  emission  is  either  imminent  or  is  in  progress  f  Is 
he  obliged  to  hinder*the  emission  ?  Most  moralists  say  no, 
for  they  say  it  is  very  difficult  or  impossible  to  hinder  it, 
and,  secondly,  semen  retentum  corrumpihir  ^  and  nobody  is 
obliged  to  expose  himself  to  the  risk  of  becoming  diseased 
through  the  corrupt  semen  by  hindering  its  emission. 

The  above  reasoning  is  incorrect.  In  answer  to  the 
first  reason,  I  remark  that  a  greater  or  less  difficulty 
should  not  be  taken  into  consideration.  I*admit  the  diffi- 
culty in  question  unhesitatingly.  If  the  emission  has  begun, 
then  that  part  of  the  semen  which  left  the  seminal  vesicles 
must  certainly  escape,  either  immediately  or  later  on,  with 
the  urine.  That  part  of  the  semen  remaining  in  the 
vesicles  will  be  affected  as  if  emission  had  not  actually 
begun,  but  was  imminent.  Whether  a  person  would  suc- 
ceed in  hindering  its  spending  itself  depends  on  circum- 
stances. But  it  does  not  follow  that  no  reasonable  attempt 
at  prevention  should  be  made.  The  complete  sexual  feeling 
accompanies  the  emission  ;  if,  therefore,  the  latter  is  suc- 
cessfully hindered,  then,  of  course,  the  danger  of  assenting 
is  very  much  lessened.  Even  if  no  success  is  attained, 
the  energetic  act  of  will  necessary  as  a  preventive  means 
renders  at  least  the  service  of  removing  the  danger  of 
assent.  Nobody  is  obhged  to  do  things  impossible,  but 
every  one  is  bound  in  this  case  to  do  his  best  j  the  more, 
because  the  second  reason,  deduced  from  the  risk  of 
disease  which  is  said  to  follow  from  the  corruption  of  the 
semen,  is  entirely  without  foundation.  There  is  no  cor- 
rupted semen,  that  is,  such  semen  as  could  in  any  way 
be  hurtful  to  the  organism.  If  a  part  of  the  semen  did 
pass  from  the  seminal  vesicles  into  the  urethra,  it  will 
escape  in  this  or  that  way,  but  always  without  detriment 


POLLUTIONS.  83 

to  health.  The  other  part  will  remain  as  it  was,  and  tvhere 
it  was.  This  is  just  as  certain  as  the  other  fact  that  the 
suppression  of  the  pollution,  even  if  there  is  a  surplus 
amount  of  it,  can  only  cause  a  passing  uneasiness,  but  can 
never  do  serious  or  lastinsr  hurt. 

I  answer  therefore  affirmatively,  that  a  person  is  obliged 
to  use  reasonable  means,  on  awaking,  in  order  to  prevent 
a  pollution  imminent  or  happening.  These  means  are  : 
to  try  to  become  fully  awake  as  soon  as  possible  ;  to  make 
an  energetic  act  of  the  will,  accompanied  by  an  elevation 
of  the  heart  to  God,  or  any  other  such  religious  act.  It 
will  usually  be  found  very  good  to  select  a  cooler  place  in 
bed,  or  to  rise  immediately.  Finally,  the  orgasm  subsiding 
a  little  (before,  it  is  generally  impossible),  I  would  counsel 
to  urinate  immediately,  for  the  filled  bladder  presses  and 
irritates  the  seminal  vesicles  that  lie  close  to  it ;  the  irrita- 
tion, therefore,  will  considerably  decrease  as  soon  as  the 
bladder  is  emptied.  I  deem  this  so  important  that  I  always 
counsel  those  who  suffer  from  rather  frequent  pollutions  not 
only  to  empty  the  bladder  thoroughly  before  going  to  bed, 
but  also  never  to  neglect  this,  when  awaking  during  the 
night. 

The  objection  is  made,  that  it  will  not  do  to  make  such 
attempts  at  prevention  obligatory,  as  it  may  lead  to  a  great 
many  scruples  and  anxieties  :  whether,  for  instance,  the 
attempt  has  been  energetic  enough  or  not.  I  do  not  share 
this  fear;  indeed  I  believe  that  this  act  of  the  will  is  very 
likely  to  calm  an  anxious  conscience.  The  question  is 
asked,  whether  one  who  knows  from  experience  that  there 
is  no  danger  of  his  assenting,  is,  nevertheless,  obliged  to 
attempt  the  suppression  ?  I  answer,  that  people  are  only 
too  readily  deceived  with  regard  to  any  such  safety 
derived  from  experience.      Besides,  why  not  make    the 


84  THE    SIXTH    COMMANDMENT. 

attempt  f  It  is  not  a  burdensome  one,  and  can  never  do 
harm.  Is  not  this  act  of  the  will  in  realitj  necessary  in 
order  to  place  one's  self  on  the  safe  side,  in  the  matter  of 
consent!  And  to  neglect  such  attempt  at  suppression, — 
does  it  not  involve  in  itself  a  serious  danger  of  assenting  ? 

As  very  frequent  pollutions,  even  in  persons  of  general 
good  health,  produce  not  only  a  more  or  less  marked 
lassitude,  but,  as  they  may  also  tend  to  become  still  more 
frequent,  it  is  not  amiss  to  give  here  some  precautionary 
measures.  Above  all,  feather-beds  should  be  avoided,  as 
also  too  vv^arm  coverings.  Lying  on  the  back  disposes  to 
dreams,  and  especially  erotic  ones  5  the  position,  therefore, 
should  be  on  one  of  the  sides,  never  on  the  back.  The 
supper  should  be  light,  not  too  rich  or  stimulating.  In 
regard  to  drinks,  all  strong  alcoholic  liquors,  as  heavy 
wines,  punch,  strong  beer,  should  be  avoided  at  night,  or 
should  at  least  be  taken  in  very  small  quantities  by  those 
who  are  disposed  to  often-repeated  pollutions.  Finally,  it 
is  necessary  to  abstain,  not  only  at  night,  but  in  general, 
from  all  stimulants,  to  take  plenty  of  exercise  in  the  open 
air,  and  to  use,  if  possible,  cold  baths.  If  medical  treat- 
ment is  necessary, — which  is  not,  however,  generally  the 
case, — it  must  be  reserved  for  the  physician. 

All  that  has  been  said  about  awaking  when  a  pollution 
is  imminent,  must  also,  of  course,  be  applied  to  pollutions 
occurring  during  the  daytime,  at  least  for  persons  either 
in  good  health,  or  of  nervous  irritability,  where  this  latter 
does  not  go  much  beyond  the  line  that  divides  health  and 
disease.  An  energetic  act  of  the  will  can  do  a  great  deal, 
the  more  so  as  the  person  is  then  entirely  awake,  and  has 
more  control  over  himself.  The  matter,  too,  has  a  differ- 
ent aspect,  in  so  far  as  there  is  generally  an  external  ex- 
citing cause  of  these  pollutions  occurring  in  the  daytime. 


POLLUTIONS.  85 

Some  erotic  impression  made  upon  the  senses  (theatre^ 
ball,  confession,  readings  of  physicians)  or  a  vivid  thought 
of  an  erotic  character,  even  should  it  be  involuntary, 
sometimes  a  purely  local  irritation  of  the  genitals,  may 
lead  to  the  danger  of  pollution,  or  even  to  the  quick  con- 
summation thereof.  If  one  can  withdraw  himself  from 
the  influence  of  causes  like  these,  he  must  do  so ,  as,  with- 
out it,  the  action  of  the  will  does  not  amount  to  anything. 
He  who  wills  an  eifect  must  will  the  means.  If  the  with- 
drawal is  impossible,  as,  for  instance,  inter  confessionem, 
or  during  medical  examinations  and  operations,  then  a 
pollution  is  free  from  sin  secluso  consensu,  as  all  moralists 
state.  Among  the  local  irritations  of  the  genitals,  that 
one  arising  from  accumulation  of  the  smegma  praeputiale 
(secretion  under  the  prepuce)  occurs  quite  frequently, 
especially  so  with  celibates,  who  generally  have  the  glans 
penis  covered  by  the  prepuce,  unless  it  is  prevented  by 
habits  of  cleanliness.  A  plentiful  and  weekly  use  of 
washes,  during  which  the  prepuce  is  drawn  back,  will  pre- 
vent this  trouble  and  its  consequences,  *  In  general, 
irritable  persons  should  be  always  counselled  to  seek  the 
advice  of  a  physician,  as  this  irritability  may  to  a  great 
extent  be  relieved  by  proper  dietetic  regimen  and  medical 
treatment. 

Finally,  we  have  to  speak  o?  i\\Q  polhdio  diurna  passiva 
(Debreyne).  Pollutions  of  this  kind,  very  happily  termed 
passive,  take  place  also  during  night,  but  then  seldom  ; 
generally  they  occur  while  the  person  is  awake,  and  also 
without  any  erotic  external  or  internal  cause  whatever,  and 

*  Such  washes  may  sometimes  .bring  on  a  provocation  to  sin.  Unnecs- 
sarj  occasion  often)p*tations  should,,  of  course;  be  avoided.  But  this  smegma, 
when  accumulating,  produces  an  irritation  more  dangerous  and  lasting, 
.•^nd  it  should  therefore  be  removed  as  soon  as  noticed  (especially  in  the 
summer). 


86  THE    SIXTH    COMMANDMENT. 

without  sexual  feeling.  This  pollution  is  often  unaccom- 
panied by  any  sensation,  and  often  occurs  with  disagreeable, 
even  painful,  sensations  of  the  genitals  and  the  neighboring 
parts.  Simple  mechanical  irritations,  as  worms  in  the 
rectum,  an  obstinate  constipation,  piles,  abrasions  of  skin 
on  the  anus,  the  above-named  accumulations  of  smegma, 
even  in  smaller  quantities,  and  most  frequently  the  irrita- 
tion during  the  movement  of  the  bowels  or  while  urinating, 
directly  cause  these  passive  pollutions.  Probably,  with 
the  exception  of  a  very  few  cases,  where  other  morbid 
affections  can  be  proved,  this  excessive  weakness  of  the 
parts  has  always  been  brought  on  by  previous  long-con- 
tinued excesses,  especially  in  the  form  of  masturbation. 
Such  unfortunate  people  exhibit  a  remarkable  feebleness 
of  will,  and,  even  should  they  for  once  be  firmly  resolved, 
they  cannot  prevent  the  evil.  There  is,  of  course,  no  new 
sin  in  these  pollutions.*  All  the  priest  can  do  is  to  guard 
them  against  another  and  irreparable  sin :  despair  and 
suicide.  They  are  not  only  utterly  wretched  in  body, 
but,  as  Debreyne  remarks,  life  becomes  to  them  an  object 
of  loathing,  and  they  are  haunted  by  an  incontrollable 
impulse  to  put  an  end  to  their  miserable  existence.  Sooth- 
ing, encouraging,  kindly,  consoling  words  may  yet  save 
these  souls.  The  patient  can  hope,  if  he  only  becomes 
emancipated  from  the  practice  of  masturbation :  and  this 
consolation  is  more  to  him  than  mere  moral  preaching. 
The  only  proper  and  necessary  advice  is,  to  tell  him  to 
confide  candidly  and  honestly  in  his  physician  ;  and  the 
consoling  assurance  should  be  given  him  that  there  is  then 
a  prospect  of  his  recovery.  In  proportion  as  the  recovery 
of  the  body  advances,  his  mind  and  feelings  also  will  be 

The  responsibility  resting  upon  them  on  account  of  those  former  excesses 
which  indirectly  cause  the  present  pollutions;  does  not  concern  us  here. 


POLLUTIONS.  87 

rehabilitated :  and  only  thus  may  his  will  regain  control 
over  his  thoughts  and  actions. 

Under  the  head  ^^  polhitio  '^  the  moralists  very  properly 
speak  also  of  the  so-called  ^^  distillation  This  distillation 
is  the  flow  of  a  mucous  fluid  from  the  urethra.  The  fluid 
is  secreted  by  the  prostate  gland  and  by  the  mucous 
follicles  of  the  membrane  of  the  urethra,  and  has  nothing 
in  common  with  the  semen  except  the  outlet.  Distillation 
may  occur  in  males  that  have  arrived  at  the  age  of  puberty, 
as  well  as  in  those  that  have  not  (also  in  castrated  persons). 
It  may  be  provoked  by  self-abusive  acts,  or  it  may  take 
place  spontaneously,  and  it  may  finally  occur  with  or  with- 
out voluptuous  sensations. 

Gury  (1.  c,  tom.  i,  page  421)  is  right  in  saying  :  ^*  Distilla- 
tio  voluntaria,  etiam  tantum  mdirectej  si  notahilis  sit,  seu 
cum  notabili  spirituum  genitalium  commotione  fiat,  peccatiim 
mortale  esse  potest,  quia  est  gravis  deordinatio  et  proximum 
pollutionis  periculum  inducit.^^  I  am  not,  however,  myself 
disposed  to  lay  much  stress  on  w4iether  or  not  the  quantity 
of  the  mucus  voided  is  notable,  but,  rather,  upon  whether 
the  commotion  is  notable  and  voluntary.  ^^  Si  vero  parva 
sit,^^  proceeds  Gury,  "  c^  absque  notahili  commotione,  distin- 
guendum  est :  1°.  Si  directe  voluntaria  sit,  nee  a  mortali 
potest  excusari ;  quia  quaecimque  distillatio  semper,  vel  ut 
plurimum,  secumfert  commotionem  et  aliquam  seminis  effusio- 
nem.  2*^.  Si  indirecte  tantum  sit  voluntaria,  facile  etiam.  ah 
omni peccato  excusabitur,  quia  de  tali  fluxu  non  est  magis 
curandum  quamde  emissione  cujuscunque  alterius  excrementi 
quo  naturd  se  exonerare  soletP 

In  1^  there  seems  to  occur  a  little  contradiction.  It  is 
said,  if  a  notable  commotion  does  not  exist ;  and,  later,  each 
distillation  is  accompanied  by  commotion.  But  this  con- 
cerns me  not.    Then  the  second  reason,  that  each  distillation 


88  THE    SIXTH    COMMANDMENT. 

is  accompanied  by  the  effusion  of  some  semen,  is  incorrect, 
because  it  is  at  variance  with  the  definition  of  distillatio. 
Practically,  it  may  be  good  to  adhere  to  it,  because  the 
penitent  cannot  know  whether  semen  may  not  have  es- 
caped at  the  same  time  ;  theoretically,  it  is  incorrect. 

To  2^  I  remark  that  I  would  not  make  the  sin  depend 
on  the  quantity  of  distillation.  I  cannot  regard  it  as  sin- 
ful, when  there  is  no  notable  excitement,  and  this  only  an 
indirectly  voluntary  one,  even  if  the  quantity  be  great. 

As  far  as  distillation  may  be  sinful,  the  same  remarks 
apply  to  its  prevention  that  have  been  made  regarding 
prevention  of  pollution. 

That  a  frequent  ^'  passive "  distillation  without  any 
commotion,  and  without  any  voluptuous  sensations,  is 
entirely  free  from  sin,  and  must  be  referred  to  a  physician, 
because  showing  a  feeble  condition  of  bodily  health,  follows 
from  what  has  been  above  said. 

To  provoke  distillation  by  wilful  self-abusive  acts  is,  in 
my  opinion,  real  and  actual  masturbation,  w^hich  I  would 
place  in  the  same  category  with  masturbation  of  females, 
but  for  the  proximate  danger  of  real  pollution.  With 
persons  that  have  not  yet  arrived  at  the  age  of  puberty, 
or  who  have  been  castrated,  the  matter  stands  exactly  as 
with  females,  because  in  both  cases  there  is  no  effusion 
of  semen.  Independently  of  the  quantity  of  the  fluid, 
the  sexual  pleasure  is  directly  consummated  by  this  kind 
of  masturbation;  and  this  ^^ masturhatio  sine  pollutione^^ 
differs,  in  my  view  as  above  given,  essentially  from  that 
tactiis  impudicus  that  is  allowed'^ at?  sordcs  abstergendas, 
ad  pruritum  seu  dolorem  sedandum  aut  ad  injirniitates 
curandas,^^ 


us  us   MATRIMONII.  89 

III.^USUS  MATEIMONIL 

1. — Onanism  :  Feccatmn  Onan. 

Guiy  (1.  c,  torn,  ii,  pag.  915)  defines:  ^' Onanismus 
in  eo  consistit,  quod  vlr,  post  inccptam  copulam,  ante 
scminationem  se  retrahat,  et  semen  extra  vas  effandat  id 
generationem  impediat.''^  This  is  the  definition  of  onanism, 
in  tlie  strict  sense  of  the  wofd.  That  it  cannot  be  allowed 
needs  no  demonstration. 

The  same  applies  to  that  kind  of  onanism  where  the 
semen  non  effunditur  extra  vas,  but  Avhere  a  second  vas 
is  contained  intra  vaSj  which  is  removed  post  copidam 
together  ivitJi  the  semen,  generation  being  thus  absolutely 
prevented.  This  latter  kind  of  onanism  is,  alas  !  so  common, 
that  the  trade  in  such  articles  (condoms,  preservatives, 
etc.)  has  become  quite  extensive,  and  is  displayed  with  bare- 
faced impudence  in  the  advertisements  of  journals  political 
and  of  polite  literature,  as  well  as  medical  and  technical. 

In  some  other  cases  a  doubt  may  arise.  In  France 
especially,  a  certain  mode  of  marital  intercourse  is  said  to 
be  of  frequent  practice,  in  order  to  prevent  or  limit  the 
procreation  of  children.  Assuming  that  there  is  a  certain 
time  when  intercourse  is  not  likely  to  cause  pregnancy, 
the  married  people  refrain  at  periods  wherein  they  believe 
that  pregnancy  will  follow,  and  they  have  intercourse  only 
at  times  when  they  believe  they  may  do  so  without 
possibly,  or  probably,  causing  impregnation.  I  can  bear 
testimony  that  this  mode  is  used  not  unfrequently  in 
Germany  also,  as  a  means  of  limiting  the  number  of 
children.  Some  there  are  that  see  herein  a  species  of 
onanism.     I  do  not  agree  with  them.     Ballerini,*  before 

*  Gurj-Balleiiiii,  1.  c,  torn,  ii,  pag.  919,  note. 


90  THE    SIXTH    COMMANDMENT. 

US,  does  not  take  this  view  of  the  matter  from  a  specula- 
tive standpoint.  Indeed,  he  does  not  even  mention  the 
thing  as  occurring  in  reality  ;  but  he  seems  to  recommend 
it,  if  incontinence  may  lead  to  an  abuse  of  marriage-life, 
shuuld  there  be,  for  some  good  reason,  a  wisli  of  limiting 
the  number  of  children.  His  reasons  are  :  ^^  Caeterum,  si 
conjugibus  licet  perpetuam  ex  communi  utriiisque  consensti 
servare  continentiam,  si  conjugibus  licet  continentiam 
servare  ac  matrimonii  consummationem  differre  ad  annos 
viginti  aut  friginta,  seu  ad  earn  usque  aetatenij  qua  nidla 
prolis  spes  jam  supersit ;  iterum  vero,  si  in  alium  matri- 
monii  legitimum  finenij  etsi  omnis  spes  prolis  adsit,  licet 
tamen  justa  de  causa  et  servato  naturae  ordine  conjugalihus 
jurihus  utij  turn  quando  uxor  certa  steriUtate  lahoratj  tu7n 
qiiando  oh  aetatem  provectam  ad  concipiendum  facta  est 
prorsus  inhahilis /  quid  demum  prohiheity  qtiominus  con- 
juges  in  finem  superius  dictum  continentiam  secundum 
normam  ac  limites  praedictos  servent  f  Aut  qua  demum 
lege  ad  congrediendum  alio  tempore  adstringi  dicemus  f  " 
1  accede  to  these  reasons  of  Ballerini,  though  herein,  of 
course,  I  have  no  voice. 

But,  with  regard  to  the  physiological  condition,  I  must 
contradict  Ballerini.  He  says  (ibidem) :  '^  Post  accuratiora 
physiologiae  studia  jam  constat,  sua  stata  esse  tempora 
quihns  e  conjugali  congressu  sperari  aut  non  spcrari  effcctus 
generationis  possit ;  et  tanquam  exploratum  jam  habetur 
sperari  ilium  effcctum  non  posse  a  quarto  decimo  die  post 
incrpta  menstrua  usque  ad  subsequcntis  epochal  fincm,  id  est 
ad  sequentem  usque  menstruorum  recursum,^^ 

It  is  by  no  means  certain  that  between  two  monthly 
periods  there  is  a  time  ever  so  short  wherein  impregna- 
tion cannot  occur.  Only  this  is  certain  that  impregnation 
will  most  easily  follow  the  copula,  if  the  latter  takes  place 


USUS   MATRIMONII.  91 

either  shortly  before,  or  (surer)  shortly  after,  menstruation, 
because  at  that  time  all  the  most  favorable  conditions  for 
it  are  present.  The  ovum  that  has  passed  from  the  ovary, 
as  well  as  the  effunded  semen,  retain  quite  certainly  for 
some  time  their  vitality  within  the  female  organ.  How 
long  this  power  of  living,  and  consequently  of  impregnation, 
lasts,  is  by  no  means  certain.  Hence  comes  it  that  the 
semen,  when  passing  into  the  womb  and  the  Fallopian 
tube,  may  find  there  an  ovum  capable  of  living  that  had 
been  expelled  for  some  time,  and  this  ovum  may  be  im- 
pregnated ;  on  the  other  hand,  an  ovum  arriving  in  the  tube  * 
may  find  living  semen  of  a  previous  copula,  and  may 
thereby  be  impregnated.  Although,  therefore,  in  propor- 
tion to  the  remoteness  (of  time)  of  copula  from  menstruation 
and  ovulation  the  likelihood  of  impregnation  decreases, 
yet  it  is  by  no  means  certain  whether  there  exists  a  period 
during  which  intercourse  will  to  a  certainty  not  be  followed 
by  impregnation. 

Even  if  the  speculative  reasonings  on  my  side  cannot 
be  maintained,  1  have  at  least  shown  that  the  opposite 
opinion,  viz.,  that  this  practice  is  a  kind  of  onanism,  has  no 
foundation.  I  think  the  question  may  be  discussed  whether 
this  mode  of  marital  life  should  not  be  recommended  in 
cases  wherein  important  reasons  render  pregnancy  un- 
desirable, or  not  advisable. 

The  moralists  further  say  :  "  Nunquam  licet  (sc.  iixon) 
directe  semen  effundere  .  .  .  unde  peccat  inortaliter  mulier^ 
quae  statim  post  copidam  mingit,  surgit^  vel  quid  aliudfacit 
animo  semen  expellendiy  (Scavini,  1.  c,  torn,  iv,  pag.  575.) 
I  think  it  best  to.  do  away  with  this  sin,  by  informing  a 
penitent  who  accuses  herself  of  such    practice,  that  her 

*  It  is  probable  that  impregnation  is  effected  mostly  in  the  Fallopiau  tube, 
not  in  the  uterus. 


92  THE    SIXTH    COMMANDMENT. 

culpable  end  will  not  be  attained.  Scavini  emphasizes 
'statini;^^  but  it  is  certain  that  the  semen,  having  once 
passed  into  the  female  organs,  will  not  so  very  easily  flow 
out.  The  walls  of  the  vagina  are  drawn  closely  together  im- 
mediately j^o.s^  viri  retraciionem^  and,  owing  to  the  capillary 
power  of  the  adjacent  walls,  the  semen  cannot  flow  out. 
Even  if  a  part  of  the  semen  should  escape,  sufficient  will 
always  be  retained.  The  best  proof  of  this  is  the  fact, 
that  impregnation  is  entirely  possible  even  stantibus  inter 
copulam  conjugibus.  But  a  washing,  or  a  removing  of  the 
semen  by  injections  into  the  vagina  shortly  after  copula, 
must,  of  course,  be  considered  as  true  onanism. 

As  in  onanism  the  fault  lies  generally  with  the  man,  it 
is  important  in  praxi : — 

1.  An  uxor  dehitum  a  viro  onanista  petere possit,  sen  tali 
viro  reddere  possit  aut  reddere  teneatur  f 

The  answer  to  this  question  belongs  to  the  moralists, 
and  their  decisions  are  clear  and  sure.  This  one  circum- 
stance has  its  weight,  from  a  physiological  standpoint,  in 
favor  of  the  affirmative  answer,  viz.:  that  it  is  by  no  means 
certain  that  the  vicious  end  is  always  attained  by  the  onanist, 
as,  against  his  will,  the  effusion  of  the  semen  will  sometimes 
take  place  in  vas,  either  partly  or  entirely.  Debreyne  (1.  c, 
pag.  162)  relates  two  cases,  in  one  of  which  seven  of  eight 
children,  and,  in  the  other,  all  the  children  (seven),  were 
generated  '^  par  surprise, ^^  where  copula  had  been  had  with 
onanistic  intention.  This  circumstance  may  be  used  with 
some  profit  in  causing  the  onanist  to  abandon  his  practice,  as 
we  n;ay  tell  him  that  it  is  ineffective  of  his  purpose. 

2.  An peccet  uxor  consensiun  internum  voliiptati  praebendo 
quando  actum  conjugalem  viro  onanlstae  permittere  p)ot€st  f 

The  moralists  answer:  ^^ JS^on  peccat,  modo  assensum 
peccato  viri  non  pracbeaty     To  the  reasons  given  in  sup- 


ABRUPTIO    COPULAE.  93 

port  of  this  answer,  another  may  be  added :  that  it  is  ask- 
ing too  much  to  forbid  consent  to  the  inevitable  con- 
sequences of  an  act  that  is  not  only  not  forbidden  to  the 
wife,  but  is  one  which  she  cannot  refuse,  and  is  not  allowed 
to  refuse.  For  the  very  reason  mentioned  before,  namely, 
that  generation  may  take  place  ^^  par  surprisej^  she  should 
do  nothing  to  hinder  the  act,  but  she  must  rather  do  all 
in  her  power  to  attain  the  legitimate  end.  But  to  resist, 
at  the  same  time,  the  consensus  internus  in  delectationem  is 
far  beyond  ordinary  human  strength. 


2. — Abruptio  Copulae  ante  Seminationem, 

a)  "  Quid  dicis,  si  femina  ante  seminationem  viri  (viz., 
without  consent  of  the  husband)  se  retrahat  f  "  "  Non  licet ^ 

b)  "  Quid  dicis,  si  vir  post  seminis  ejffusionem  se  ictrahat, 
quin  adhuc  mulier  seminaverit  f  "  "  Commune  est/^  says 
Scavini  (L  c,  tom.  iv,  pag.  576),  '^ posse  se  tactibus  mulierem 
statim  ad  seminandum  excitare,  quia  hoc  pertinet  ad  comple- 
mentiim  actus  conjugalis.  Esto  quod  seminatio  midkris  non 
sit  necessaria,  sed  summopere  confert,  cum  natura  nihil  moli- 
atur  frustra.  Atque  ex  hoc  deducere  est,  peccare  midiereSj 
quae  in  actu  copulae  animum  in  alia  divertunt,  ne  conciten- 
tur  ad  seminationem  :  sicut  vir  peccat,  qui  nitdieris  semina- 
tionem non  expect  at. ''^ 

Although  the  seminatio  feminae  aliquid  confert^  it  is, 
absolutely  speaking,  not  necessary  for  impregnation :  her 
diversion,  therefore,  to  other  matters  will  be  of  no  practical 
effect,  either  the  one  way  or  the  other.  Thus  this  sin,  which 
exists  only  in  the  intention,  may  be  done  away  with.  To 
impose  upon  the  man  under  sin  expectare  mulieris  semina- 
tionem is  to  exact  what  is  not  possible,  under  penalty  of 


94  THE    SIXTH   COMMANDMENT. 

sill.  After  effusio  seminis  there  follows  nearly  always,  and 
almost  immediately,  a  relaxatio  partium  viriUiim,  which 
makes  a  continuation  of  copula  ad  producendam  -feminae 
seminationem  impossible.  Debreyne  (1.  c,  pag.  184)  says  : 
"  Je  ne  vols  que  la  prolongation  de  Facte  conjugal,  on  un 
nouvel  a^tj  qui  soit  complet  et  normaV^  How  a  physician 
can  sustain  this  opinion,  I  cannot  understand.  Generally 
neither  the  one  nor  the  other  will  be  possible,  at  least  not 
immediately,  nor  shortly  after  the  copula.  If  a  longer 
interval  is  interposed,  the  object  of  such  practice  is  lost, 
be  this  object  either  the  seminatio  feminae — which  apper- 
tains, as  is  pretended,  to  the  completion  of  the  act — or  be  it 
the  levamen  necessarium  of  the  wife.  Hence,  because 
snch  a  demand  cannot  be  complied  with  in  general,  accord- 
ing to  physiological  laws,  and  further,  because  the  seminatio 
feminae  is  not  necessary  to  obtain  the  real  end  of  copula, 
there  seems  to  be  no  sin  on  the  part  of  the  man.  The 
other  question  is  :  "  Utnim  feminae  licitum  sit,  post  retractio- 
nemet  seminationem  viri,  sese  tactihus  excitare  ad  propriam 
seminationem,  ut  sihi  levamen  necessarium  procuret  f  "  ^^Si 
hoc  2>ermitteretur  uxoribus,^^  says  St.  Alphonss  (lib.  vi,  n. 
919),  ^^  deheret  permitti  etiam  viris,  casu  quo  mulier  post 
suam-  seminationem  se  retralieret,  et  vir  maneret  irritatus.^^ 
Here  Debreyne,  who  quotes  this  passage  in  order  to  sup- 
port his  own  views,  is  rather  unfair.  Liguori  (I.  c.)  remarks, 
first,  that  some  authors  answer  negatively  (dicenteSj  id  non 
ecce  licitum,  si  mulier  posset  se  continere).  ^^ Ratio  est,  quia 
semen  midieris  non  est  necessarium  ad  generatiotiem ;  item 
quia  effusio  ita  mulieris,  utpote  separata,  non  fit  una  caro 
cum  viro^  He  proceeds :  "  Communius  vero  affirmant. 
Matio,  turn  quia  seminatio  midieris  pertinet  ad  complendum 
actum  conjugalem,  qui  consistit  in  scminatione  utriusque 
conjugis  ;  unde  sicid  potest  uxor  tactihus  se  praepararc  ad 


ABRUPTIO    COPULAE.  95 

coptilam,  ita  etiam  potest  actum  copulae  perficere :  turn  qttia, 
si  midieres  post  talem  irritationem  tenerentur  naturam  coin- 
pescere,  essent  ipsae  jugiter  magno  periculo  expositae 
mortaliter  peccandi,  cum  frequentius  viri^  quia-  calidioreSj 
prius  seminent  (sed  Jiaec  ratio  non  suadet^  nam,  si  hoc  per- 
mitteretur  uxorihus,  deheret  pennitti  etiam  viris,  casu  quo 
midier post  suam  seminationem  se  retr alter et^  et  vir  mcmeret 
irritatus :  at  DD.  communiter  dicuntj  id  vetitum  esse  viris^ 
ut  Sancli.j  p.  lOj  Wiegand  et  Bon.,  L  c);  turn  quia,  ut plures 
sentiuntj  se^ninatio  midieris  est  necessaria,  vel  saltern  midtum 
confert  ad  generationem',  nihil  enim  a  natura  frustraneum 
agitur.  Omnes  autem  concedunt  tixoribiis,  quae  frigidioris 
sunt  naturae  J  posse  tactihus  se  excitare  ante  copulamut  semi- 
nent in  congressu  maritali  statim  hahendo.^^  The  sentence 
quoted  by  Debrejne  is  only  between  brackets,  and  is 
directed  only  against  that  argument,  that  the  wife  should 
be  allowed  statim  se  excitare  post  copulam,  on  account, 
of  the  difficulty  of  ^^  compescere  irritationem.'^^  Liguori 
rejects,  as  it  seems,  this  reason,  whilst  he  seems  to  accept 
the  two  others.  The  first  of  these  two  is  expressed  by 
Gury  (1.  c,  torn,  ii,  pag.  914)  with  still  greater  terseness : 
'*  Quia  seminatio  mulieris  pertinet  ad  complendum  actum 
conjugalenij  ut  prqprie  conjitges  sint  una  caro^  This  is 
directly  the  opposite  of  the  term  which  is  used,  according 
to  Liguori,  by  the  opponents  of  this  opinion :  ^^Quia  effusio 
ilia  midieris^  utpote  separata^  non  fit  una  caro  cum  viroJ^ 
Without  intermeddling  in  this  controversy  of  the  theo- 
logians, I  incline  to  the  view  of  Gury.  The  marriage  gives 
to  both  parties  the  right  of  gratification  of  the  volaptas 
(propter  periculum  incontinentiae J  :  now,  if  the  legitimate 
act  ordained  for  this  end,  and  properly  executed,  as  far  as 
possible,  does  not  give  this  gratification  to  the  wife  without 
any  fault  on  her  part,  it  seems  to  me  that  she  is  allowed  to 


96  THE   SIXTH   COMMANDMENT. 

procure  it  by  tacfuSj  in  immediate  continuation  of  the  act, 
whether  these  tactus  be  made  by  herself  or  by  her  husband. 
This  opinion  of  mine  gains  strength  by  the  very  reason 
rejected  by  Liguori.  There  will  be  great  difficulty  in  sub- 
duing the  irritation  that  is  nearly  always  present  under 
these  circumstances.  Now,  this  irritation  is  caused  by  an 
act  that  is  allowed.  Can,  therefore,  the  wife  be  obliged, 
under  such  a  difficulty,  to  avoid  a  thing,  the  effect  of  which 
she  has  a  right  to  by  marriage  ?  This  cannot  be  held ;  and 
the  less  so,  as  very  often,  as  Liguori  correctly  remarks, 
^he  seminatio  viri  ensues  ante  seminationeni  feminae.  A 
great  many  wives  would  thus  be  placed  in  very  grave 
periculum  peccandi  which  they  could  not  avoid ;  and  not 
to  succumb  to  it,  on  frequent  repetition,  would  seem  to  be 
beyond  the  power  of  human  nature. 

Indeed,  I  would  rather  ask  whether  a  wife  is  not  al- 
lowed statim  x>ost  viri  retractionem  sese  tactihus  excitare  ad 
propriam  seminationem,  even  when  the  vir  onanista  ante 
seminationeni  se  retraJiitj  and  the  wife  is  placed  in  tali 
irritatione.  The  circumstances  on  the  part  of  the  wife  are 
similar  as  post  seminationem  viri.  The  moralists  declare 
it  to  be  allowed  that  the  wife,  at  the  copula  cum  viro  ona- 
nista, may  give  her  consensus  in  delectationem  ex  copula  ilia, 
— modo  assensum  viri  peccato  non  pracheat :  hence,  even 
in  such  a  case,  the  delectatio  is  not  a  thing  forbidden  in 
itself  to  the  wife.  Why,  then,  not  grant  to  the  wife,  in  the 
supposed  case,  as  her  due,  what  is  kept  from  her  only  by  the 
sin  of  the  husband  ?  If  she  can  abstain,  so  much  the  better  j 
but  this  is  a  very  difficult  thing  for  natural  reasons. 

I  have,  here,  purposely  abstained  from  the  use  of  the  term 
seminatio  as  regarding  the  wife,  and  I  have  mentioned 
with  emphasis  only  the  voluptas.  This  leads  us  to  the  third 
reason    given   by  Liguori :    Ncccssaria   ad  generationem 


ABRUPTIO   COPULAE.  97 

omnino  non  est  seminatio  feminae.  This  has  been  demon- 
strated by  well-proved  facts,  and  is  nowadays  considered 
certain.  Besides,  it  seems  very  doubtful  whether  a  copula, 
complete  on  the  part  of  the  wife,  is  always  accompanied  by 
an  effusiOj  or  so-called  seminatio.  That  the  irritation  of  the 
genitals  during  copula,  and  especially  when  voluptas  com- 
pleta  is  experienced,  causes  a  secretion  of  the  mucous 
membranes  of  these  organs, — that  is,  in  quantity  greater 
than,  but  in  quality  the  same  as,  the  ordinary  secretion^, — 
is  correct,  at  least  as  far  as  the  vagina  is  concerned.  How 
far  the  uterus  is  thus  affected,  is  not  surely  known.  If 
there  is  an  increased  secretion  from  the  uterus, — that  is  to 
say,  especially  from  its  vaginal  part  (cervix), — then  this 
might  promote  impregnation,  in  so  far  as  the  same,  being 
alkaline,  may  change  the  quality  of  the  acrid  vaginal 
secretion,  and  may  thus  be  apt  to  preserve  a  longer  power 
of  living  to  the  semen  ;  further,  perhaps,  by  freeing,  through 
and  during  its  flow,  the  mouth  of  the  womb  from  the  rather 
clammy  secretion  usually  adhering  to  it,  and  by  rendering 
the  womb  thus  more  accessible  to  the  semen.  This  would 
be  useful,  especially  in  the  case  of  women  who  have  not 
yet  given  birth  to  children. 

On  the  other  hand,  it  can  be  correctly  maintained  that 
the  voluptas  completa  is  probably  more  conducive  to  con- 
ception than  the  hypothetical  seminatio.  The  intense  local 
excitement,  the  turgidity  of  the  internal  sexual  organs, 
which  accompanies,  physiologically,  the  solution  of  this 
voluptas,  must  be  of  great  influence  on  the  organs  that 
are  lined  all  over  with  muscular  fibres.  But  the  matter 
is  too  complicated  to  be  explained  here.  Besides,  there 
have  not  been,  or  scarcely  any,*  observations  made  on  a 

*  Observ^ations  of  this  and  of  a  similar  kind,  even  to  experiments  of  arti- 
ficial impreguadou  of  the  human  female,  made  hy  the  Americau  Dr.  J. 


98  THE   SIXTH   COMxMANDMENT. 

living  person,  for  reasons  easily  understood.     I  may  only 
say  that  the  turgidity  caused  by  the  excitement,  the  con- 
traction of  the  muscular  fibres,  and  also  the  stronger  ac 
tion  of  the  fimbria, — all  probably  help  to  bring  ovum  and 
semen  in  more  sure  and  ready  contact. 

A  necessitas  ad  generationem  cannot  be  conceded  to  the 
feeling,  as  it  cannot  to  the  seminatio  feminae.  Yet  it  must 
be  admitted  that  it  is  possibly,  and,  perhaps,  probably,  very 
useful.  This  circumstance  in  my  eyes  has  some  weio^ht 
for  the  opinion,  quod,  si  vir  se  retrahat  post  seminis  effusio-' 
nenij  mulier  statim  tadibus  se  excitare  possit,  ut  '^  semineV^ 

In  connection  with  the  above-quoted  dictum  of  Liguori : 
"/Si  hoc permitteretur  uxoribuSj  deheret permitti  etiam  viris, 
casii  quo  midier  post  suam  seminationern  se  retraheret  et 
vir  maneret  ii'riiatus,^^  I  may  add,  in  order  to  avoid  any 
misunderstanding,  that  this  conclusion  does  not  seem  to  me 
corectly  drawn.  The  conditions  are  entirely  unequal. 
There,  post  viri  seminationern,  that  part  of  the  copula 
which  is  essentially  necessary  for  generation,  namely, 
seminatio  viri  intra  vas  fcminale,  is  completed,  and  the 
wife  is  allowed,  for  the  reasons  given,  to  add  the  levamen 
neccssarium  ad  complcmentum  actus  perfecti,  which  is  not 
essential  for  generation.  Here  only  the  seminatio 
feminae  has  taken  place,  which  is  not  essentially  neces- 
sary for  generation,  and  is  allowed  only  in  connection  with 
the  actus  ad  generationem  apt  us ;  but  the  essentially 
necessary  part,  namely,  the  seminatio  viri  intra  vas,  is 
hindered  by  the  action  of  the  wife.  Thereby  the  act  ceases 
to  be  an  allowed  one,  and  every  thing  that  is  done  from 
this  moment  ad  x^rocreandam  seminationern  (except  an- 

Marion  Sims  (who  stands  almost  alone  lierein)  will  scarcely  ever  be  con- 
tinued to  such  an  extent  as  to  allow  a  certain  judgment  of  these  matters, 
which  are  so  far  withdrawn  from  human  knowledge. 


ABRUPTIO    COPULAE.  99 

other  introdudio  in  vas)  cannot  be  considered  as  com- 
plemcntum  actus j  because  the  act  is  neither  complete,  nor 
is  it  intended  to  complete  it.  The  excitatio  viri  ad  semi- 
nationem  would  be  a  real  pollution.  This  much  is  here 
certain,  feminam  pcccarCj  si  viri  seminationem  non  ex- 
pectat.  She  acts  either  with  an  onanistic  intention,  or  it 
is  a  very  culpable  egotism  on  her  part,  which  places  the 
man  in  a  grave  danger  of  sin. 

c)  The  third  form  under  which  ahruptio  copulae  ante 
seminationem  can  be  practised,  is  the  interruption  of  the 
act,  on  the  part  of  the  man,  after  the  seminatio  *  feminae 
has  taken  place,  but  before  the  emission  seminis  virilis 
ensued.     Is  this  allowed  ? 

Liguori(lib.  vi,  918  alinea  2)  says:  ^'  Si vero  femina  jam 
seminaveritj  vcl  sit  in  prohahiU  periculo  seminandij  non 
potest  qiiidem  vir  data  opera  a  seminatione  se  retrahere  sine 
gravi  culpa;  quia  tunc  ipse  est  causa,  ut  semen  uxoris 
prodigaturj  communiter  dicunt  (auctores  nonnulli).  Hoc 
tamen  non  erit  ita  intrinsece  malum,  ut  aliquo  casu  per- 
mitti  non  possit :  ptita  si  vir  desisteret  a  copida  oh  peri- 
culum  mortis,  vel  scandali  aliorumJ^  I  would  add  that 
great  fatigue  on  the  part  of  the  man  is  also  sufficient 
excuse,  if  no  danger  of  pollution  exists.  With  the  same 
limitation,  an  over-exhaustion  of  the  wife  must  be  regarded 
as  sufficient  excuse  for  the  man.  Lastly,  it  may  happen 
that  the  act,  begun  petente  uxore,  is  followed  by  semi- 
natio on  her  part,  whilst  the  man  is  convinced  that,  even  by 
longer  continuation  of  the  act,  an  effusio  seminis  on  his 
part  cannot  probably  be  expected.  In  this  case,  nothing 
can  oblige  the  man,  not  even  suh  levi,  to  continue  the  act. 
In  order  to  show  how  little  circumstances  may  otherwise 

*I  retain  this  term,  although  I  understand    by  it,  less  an  emlssio  seminis 
muliebris,  than  the  solution  of  the  volaptas  on  her  part. 


100  •  THE    SIXTH    COMMANDMENT. 

justify  such  a  proceeding,  I  ask:  If,  post  feminae  semi- 
nationenij  the  husband  is  seized  by  a  cramp,  say  of  the  leg 
or  foot  (as  happens  often  enough,  even  independently  of 
copula),  is  he  obliged  to  continue  the  act ! 

d)  Finally  the  question  arises :  An  peccant  mortdliter 
conjiiges,  sij  incepta  copula,  cohibeant  seminationcm  ;  that 
is,  if  they  interrupt  the  act  without  semination  having 
taken  place  in  either  of  them  ?  It  is  undisputed  :  Si  alter 
se  retrahit  sine  alterins  consensu,  certe  graviter  peccat. 

'^  Si  vero,^^  says  Liguori  (lib.  vi,  918)  '^  conjuges  ambo 
in  hoc  consentiuntj  nee  adsit  periculum  seminandi  extra  vas, 
id  per  se  loquendo  non  est  mortale;  ilia  enim  penetratio 
vasis  feminei  tunc  reputatur  instar  tactus  verendorum,  qui 
inter  conjuges  permittiturj  vel  saltern  non  est  mortalis, 
secluso  periculo  pollutionis  ;  ita  communiter.  ,  .  .  Dm,  1,  si 
ambo  consentiuntj  nam.  .  .  .  Dixi,  2,  ^jer  se  loquendo,  nam 
sapienter  advertit  Sanch.,  1.  c,  cum  Veracrux,  idordinarie 
esse  mortale,  quia  ordinarie  adest  periculum  ex  tali  retrac- 
tione  effundendi  semen,  nisi  conjuges  experti  sunt  oppositum  : 
quo  casu  tamen  puto  nullo  modo  posse  eos  excusari  saltern  a 
vcniali,  quidquid  dicat  Sanch.,  ibid.,  cum  aliis.^^ 

Ballerini,  who  says  for  himself  (Gury,  1.  c,  torn,  ii,  pag. 
911,  note  6)  that  he  does  not  see  a  grievous  sin  in  it,  also 
defends  an  opinion  of  Diana  (ibidem) :  "  Communiter, 
cessante  in  utroque  conjuge  pollutionis  periculo,  non peccare 
inaritum  mortaliter,  si  coeptam  copulam  ante  seminationem 
abrumpat,  ne  proles  gcncretur,  modo  id  facial  uxore  consen- 
tiente  aut  non  rationabiliter  invita.  Immo  si  justa  causa 
adsit  impediendi  seminationem,  v.  g.,  6b  paupertaiem  ae 
multitudinem  prolis,  et  nihilominus  concubandi  ad  sedandam 
concupiscentiam,  omnem  culpam  abesse,  si  mutuus  consensus 
accedat.  .  .  .  Unde  non  erunt  damnandi  etiam  de  culpa 
veniali  conjuges  infirmi,  qui  ad  sedandam  coneupiscentiam 


ABRUPTIO   COPULAE.  101 

inciperent  copulam,  et  voluntarie  illam  minime  perficerent : 
et  hie  casus  freq^uenter  potest  acciderey  He  further  quotes 
Liguori's  (lib.  vi,  934).  opinion  that  is  said  to  be  sat  com- 
munis^ "  quae  {opinio)  lies  actus  excusat  ab  omni  culpa  etiam 
in  petente,  si  pollutio  nan  intendatur  ;  nee  adsit  periculum 
consensus  in  earn  et  modo  ,  .  .  adsit  gravis  aliqua  causa^ 
V.  g.,  ad  fovendum  mutuum  amorem  aut  ad  avertendain 
alter ius  zelotypiamy 

I  state  here  that  Ballerini  is  not  accurate  in  his  quota- 
tion ;  and  that,  besides,  he  left  out,  amongst  other  lessor 
points,  one  determining  sentence  of  the  last  quotation  from 
Liguori.  In  the  space  of  the  dots  between  the  words 
modo  and  adsit^  we  have  in  Liguori :  *'  (Et  modo),  tactus 
non  sit  adeo  turpis.  ut  judicetur  inchoata  pollutio^  prout 
esset,  digitum  morose  admovere  intra  vas  femineum ;  ac 
praeterea'^  (adsit,  etc.,  as  above).  If  here  morosa  introdiictio 
digiti  judicatur  inchoata  poUictio,  is  it  not  much  more  in- 
choata poUutiOj  when,  instead  of  the  introductio  digiti, 
introductio  penis  is  substituted  ?  In  such  a  case,  the 
excitement  in  both  parties  is  greatly  increased,  Sind pericu- 
lum poUutionis  post  retractionem  is  rendered  more  imminent. 
This  quotation,  therefore,  cannot  be  used  to  show  that  a 
discontinuance  of  coepta  copula  is  allowable. 

I  can  by  no  means  approve  of  the  opinion  that  such  a 
discontinuance  of  copula  is  allowed  under  the  conditions 
and  reasons  above  stated.  He  who  does  not  desire  the 
generatio  prolis  should,  in  my  opinion,  abstain  from  copula. 
What  is  to  be  attained  by  such  an  incomplete  copula  I 
The  proper  and  immediate  end  of  the  act  is  made  void ; 
it  can,  therefore,  take  place  only  ad  fovendum  mutuum 
amorem,  ad  'avertendam  aUerius  selotypiam  (! ),  ad  sedan- 
dam  concupiscentiam.  There  are  other  means  to  pro- 
mote the  mutual  love  of  man  and  wife,  such  as  oscula^ 


102  THE    SIXTH    COMMANDMENT. 

ampJexiones,  tadiis  minus  turpes,  that  are  suited  to,  quite 
sufficient  for,  and  are  also  allowable  between  married  people, 
even  should  a  not  intended  pollution  follow.  The  reason, 
ad  avertendam  alterius  zelotypiam,  falls  under  the  same 
category,  and  is  only  the  negative  side  of  the  former.  The 
last-named  reason,  namely,  ad  sedandam  concupiscentiam, 
will  always  remain  the  principal  one.  But,  even  for  this 
end,  tactiis  impiidici  between  married  people  can  be  re- 
garded as  allowable,  only  so  far  as  they  do  not  in  them- 
selves, of  their  own  nature,  bring  on  proMmum  periculum 
pollutionis  ;  or,  to  use  the  words  of  Liguori,  are  not  instar 
incJwatae  pollutionis.  And  how  can  an  act  serve  ad  sedan- 
dam  concupiscentiam,  which,  by  its  very  nature,  tends  to 
increase  concupiscence  1  This  is  sheer  contradiction.  Even 
on  the  supposition  that  there  is  no  consensus  in  pollutionemj 
there  is  certainly  always  proximum  periculum  pollutionis. 
But  Liguori,  as  well  as  Diana,  requires  explicitly  that 
there  exist  no  such  danger  on  either  side.  If  the  concu- 
piscentia  urges  on  to  copulay  then  the  act  begun  is  surely 
accompanied  by  a  proximate  danger.  Otherwise,  if  the 
concupiscentia  is  so  little  increased,  and  the  delectation  so 
slightly  excited  by  the  copula  coepta,  that  even  then  there 
is  no  periculum  poUutionis,  then,  most  assuredly,  the  con- 
cupiscence was  not  so  strong  but  that  it  could  have  been 
very  easily  overcome.  I  do  not  see  how  such  a  proceeding 
can  be  allowed  even  for  conjuges  injirmi ;  for,  if  they  are 
feeble  and  sick  to  such  a  degree  as  to  fear  considerable 
harm  from  the  copula,  they  must  simply  abstain  from  it. 
If  from  their  feebleness  they  fear  inability  to  complete 
the  copula,  they  must  be  considered  like  old  people.  (See 
below  under  "  Matrimony.") 

Besides,  it  is   certain    that    the   copula  propter   solam 
voluptatem  is  not  allowed  ;  that  is  to  say,  that  the  complete 


ABRUPTIO    COPULAE  ANTE   SEMINONATIEM.        '   103 

copula  practised  onhj  for  the  purpose  of  volaptas  {ad  sedan- 
dam  concupiscentiam)  with  the  explicit  exclusion  of  the 
purpose  of  generation,  is  at  least  a  venial  sin,  according  to 
the  common  sentence  of  all  moralists.  Now,  how  can 
there  be  no  sin  in  this  case,  where  only  volaptas  is  sought 
for,  and  where  the  purpose  of  generation  is  excluded  ex- 
plicitly  f  Is  there  not  therein  a  grave  sin,  at  least  in 
general,  on  account  of  the  very  imminent  danger  of 
pollution  ?  I  cannot  imagine  any  reason  which  could  justify 
such  a  proceeding.  The  case  which  would  seem  to  afford 
the  strongest  grounds  of  justification  is,  when  the  wife  runs, 
to  a  certainty,  a  great  risk  of  life  through  gestation.  But 
even  in  this  case  I  adhere  to  the  opinion  I  have  already 
given.  Such  a  case  would  be  indeed  distressing,  but  it 
must  be  borne  by  Christian  persons.*  Even  in  order  to 
avoid  danger  of  life,  nobody  is  allowed  to  commit  a  venial 
sin;  much  less,  to  expose  himself  to  such  a  direct  and 
proximate  danger  of  mortal  sin. 

But  the  aspect  may  be  changed  by  a  circumstance 
which  I  do  not  find  mentioned  explicitly.  It  is  certainly 
not  the  same,  whether,  1,  before  beginning  the  copula, 
the  intention  is  to  begin  it  for  any  reason,  and  then  to 
break  it  off  ante  seminationem  utriusgue  conjugis,  ne  pro- 
les generetur ;  or  whether,  2,  the  act  is  begun  without 
such  an  intention  of  interruption,  and  is  for  some  reason 
interrupted,  both  consenting,  ante  seminationem. 

The  first  case  has  been  supposed  in  the  former  argu- 
ment, and  can  never,  in  my  opinion,  be  allowed. 

In  the  second  case,  the  matter  presents  itself  under  a 
different  aspect.  Here  the  act  is  rite  begun ;  generation 
is,  perhaps,  not  thought  of  as  the  ultimate  end,  but  most 

*  This  is  one  of  the  cases  where  I  should  think  the  mode  of  marital  life, 
referred  to  on  page  91,  ought  to  be  recommended. 


104  THE    SIXTH    COMMANDMENT. 

moralists  do  not  require  such  an  intention,  if  it  is  only  not 
explicitly  excluded.  Under  these  circumstances  genera- 
tion is  implicitly  the  ultimate  object,  and  the  copula  is 
undoubtedly  allowed,  even  should  the  voluptas  be  the  end 
that  is  just  then  thought  of.  Now,  suppose  both  consent 
to  interrupt  the  act  for  some  good  reason,  ante  semina- 
tionem  utriusqne  (or  also  ante  seminationem  viri),  it  is  only 
necessary  that  one  condition  be  fulfilled,  namely,  that  there 
be  no  periculum  polhitionis.  In  the  case  first  named,  this 
condition  can  exist  only  with  the  greatest  difficulty,  oi 
may  be  not  at  all,  because  no  one  can  know,  at  the  begin- 
ning of  the  copula,  whether,  or,  if  so,  how  soon,  pericu- 
lum pollutionis  will  occur.  But  here  this  condition  can 
very  well  be  fulfilled.  For,  at  the  moment  when  the  con- 
juges  agree  to  interrupt  the  copula,  they  can  know  whether 
or  not  there  is  periculum  pollutionis.  If  the  danger  exists, 
the  interruption  would  be  a  grave  sin  according  to  all ; 
if  not,  I  do  not  see  any  sin  at  all,  not  even  a  venial  one. 
Those  authors  who  do  not  find  any  sin,  or  only  a  venial 
one,  in  the  discontinuance  of  the  act  ante  seminationemj 
perhaps  had  it  so  in  their  minds  *,  but  they  did  not  express 
it  explicitly,  as,  I  think,  they  should  have  done.  Practi- 
cally, the  first,  that  is,  the  unpermitted  act,  will  certainly 
happen  oftener  than  the  second. 

To  make  this  matter  complete,  I  may  mention  :— 

3. — Situs  Conjugum  in  Copula, 

Omnis  situs  etiamsi  innaturalis  in  copula  {vel  stando  veJ 
sedendOj  vel  more  pecudum  vel  a  latere,  vel  viro  succum- 
hente)  per  se  non  ecccedit  culpam  venialem^  dummodo  actus 
conjugaJis  satis  perfici  possit : — ''Mutatio  situs  generationem 
non    impeditj  cum  semen  viri  non  recipiatur  in  matricem 


SITUS  CONJUGUM   IN   COPULA,  105 

mulkris  per  infusionem,  seu  descensum,  sedper  attradionem, 
dum  matrix  ex  se  naturaliter  virile  semen  attrahat.^^  (Lig., 
lib,  vij  9 1 7.)  "  Et  ideo  nullum  etiam  erit peecatiim^  si  modus 
naturalis  muietur  oh  aliqiiam  jiistam  causam,  v.  g.^  aegritu- 
dinis,  pericidi  abortus j  scandali^  difficuUatis,  etc^  ut  ait  Con- 
cinna."  (Scavini,  torn,  iv,  574.)  Guiy  (1.  c,  ii,  pag.  902) 
sums  up :  'H°  Minime  peccant  conjuges,  qui  situm  invertunt 
ob  periculum  abortus  tempore  praegnationis,  ob  viri  pingui- 
tudinem  vel  curvitatem^  ob  nimiam  mulieris  defatigationem, 
aut  etiam  ob  frigiditatem,  quando  innaturali  situ  magis 
excitentur,  etc.  2°  Sitics,  qui  solus possibil is  est,  qualiscunque 
demum  sit,  nullatenus  damnaturj  licet  non  modica  seminis 
perditio  sequatur  ;  quia  pars  ista  non  est  generationi  neces- 
saria,  et  per  accidens,  invitis  conjugibus,  deperditurJ'' 

Dummodo  actus  conjugalis  satis  perfici  possitj  that  is 
to  say,  if  the  introductio  in  vas  is  possible,  and  if  the 
emissio  seminis  in  vas  can  be  effected.  The  infusio  in 
vaginam  is  quite  sufficient.  For  anatomical  reasons,  a 
directa  infusio  in  uterum  does  very  seldom  take  place, 
and  never  the  descensus  (by  gravity).  The  semen  is  taken 
into  the  womb,  partly  by  the  movements  of  the  muscles 
and  of  the  cilia  of  the  mucous  membranes  ;  partly,  by  the 
spontaneous  movements  of  'the  spermatozoa  (seminal 
animalcules).  Thus  the  situs  in  copula  is  entirely  in- 
different as  regards  reception  of  the  semen  in  uterum.  In 
some  situs  there  may  be  a  partial  perditio  seminis  post 
infusionem  in  vaSj  but  not  to  such  an  extent  as  to  prevent 
concepdon.  Experience  proves  that  a  very  small  quantity 
of  the  semen  suffices  for  generation.  I  have  nothing  to 
add  with  regard  to  the  just  causes  enumerated  by  Gury. 

4.  Finally,  we  have  to  speak  of  copula  in  certain  con- 
ditions, such  as  menstruation,  gestation,  lying-in  period, 
lactation,  disease,  etc. 


106  THE    SIXTH    COMMANDMENT. 

a. — Tempus  Menstruationis, 

Most  moralists  regard  the  act  during  menstruation  as 
peecatum  veniale  in  se  oh  indecentiamj  quam  prae  se  ferre 
videtur  /  but  as  allowable,  si  accedit  aliqua  causa  co- 
honestans,  e.  g.,  ad  vitanda  dissidia^  ad  incontinentiam 
praecavendam,  etc.  The  indecentia  is  no  doubt  great 
enough,  and  one  should  think  that  concupiscence  could  be 
overcome  during  this  period;  but  de  gustibus  non  est 
disputandtim.  Besides,  I  do  not  believe  the  act  to  be 
invariably  innocuous. 

Indeed,  the  injury  possibly  arising  to  the  man  is  un- 
important, and  will  generally  amount  to  nothing.  The 
consequences  of  leprosy  or  monstrosity  with  which  the 
eventual  foetus  was  supposed,  in  former  times,  to  be 
visited,  are  entirely  fabulous,  and  never  happen.  Even  the 
debility  of  a  child  generated  at  this  time  cannot  certainly 
be  predicted.  But  it  is  not  at  all  certain  that  the  female 
organs  are  not  liable  to  suffer  from  the  irritation  accompany- 
ing the  copula,  as  they  are  already  at  this  period  in  a 
state  of  congestion.  Injury  in  this  manner  is  possible 
a  priori.  Congestive  affections  of  longer  duration  may  be 
caused,  which,  on  their  part,  may  be  followed  by  a  sure 
danger  of  miscarriage.  Besides,  such  affections  may  lead  to 
serious  long-continued  disorders  of  the  generative  organs. 
To  point  out  the  possibility  of  serious  damage  on  the  part 
of  the  wife  is,  therefore,  of  weight  to  restrain  married 
people  from  this  certainly  most  indecent  use  of  marriage 
relations. 

The  moralists  distinguish  here  between  menstruation 
proper  and  s^fluxus  extraordlnariuSj  which  lasts,  sometimes, 
for  a  very  long  time.  In  the  latter  case,  copula  is  allowable, 
according  to  the  more  common   opinion,  "  turn  propter 


COPULA  TEMPORE  PURGATIONIS.         107 

hifirmitafemj  quia  miilier  in  tali  statu  concipere  non  potest, 
turn  quia  talis  fluxus  est  perpetuus  et  diuturnuSj  imde  opor- 
tef,  quod  vir  perpetuo  abstinerety  * 

The  first  reason  has  no  force,  from  a  medical  point  of 
view,  as  appeared  in  mj  remarks  made  on  regular  men- 
struation. Direct  injury  to  the  child  that  may  be  generated 
is  not  to  be  feared  from  the  act,  but,  perhaps,  an  indirect 
one  through  disease  of  the  womb  setting  in.  The  second 
reason  would  be  valid  but  for  the  circumstance,  that  the 
generative  organs  of  the  wife  are  injured  by  the  act  under 
such  conditions.  It  cannot  be  hoped  for,  much  less  taken 
for  granted,  that  there  will  be  no  harm  done.  For,  a  fluxus 
extraordinariiis  takes  place  only  in  consequence  of  a  dis- 
eased condition  of  the  generative  organs.  The  presumption, 
therefore,  is,  that  this  diseased  condition  will  be  rendered 
worse,  or,  at  least,  may,  possibly,  be  rendered  worse  per 
irritationem  ex  copula.  In  many  disorders  of  this  kind, 
the  fact  is  really  so :  details  are  not  necessary  here.  In 
such  cases,  the  physician  should  be  consulted  as  to  whether 
the  copula  is  allowable.  If  practised  against  his  counsel, 
there  would  be  at  least  a  venial  sin,  and,  in  certain  contin- 
gencies, perhaps  a  mortal  one. 


h. — Tempus  Turgationis :  Lochial  Discharge. 

Similar  to  what  has  been  said  of  fluxus  extraordinarius 
applies  here.  The  greater  number  of  moralists  hold  that 
copula  at  this  time  is  allowable,  otisi  ex  concubitu  gravis 
morbus  vel  notabilis  aggravatio  morhi  immineat,  ut  si  ac- 
cessus  haheretur  ipso  die  partus,  vel  die  suhsequente. 
Injury  to  the  man  is  not  to  be  feared ;  nor  can  it  be  supposed 

*Liguori,  lib.  vi;  925. 


108  THE    SIXTH   COMMANDMENT. 

to  arise  for  the  child,  for  there  is  no  conception  at  this  period. 
Not  to  speak,  however,  of  the  indecencj,  which  is  still 
greater  here  than  during  menstruation,  the  copula  appears 
to  me,  at  least  if  it  takes  place  during  the  first  few  weeks 
after  parturition,  as  a  sheer  act  of  rudeness  to  the  Ijing-in 
woman.  The  wife  has  just  passed  through  the  most  im- 
portant period  of  her  life  j  her  pains,  although  physiological, 
have  been  verj  severe,  and  these  same  in  the  generative 
organs  j  so  much  so,  that  even  the  healthy  lying-in  woman 
feels  herself  very  much  weakened  and  distressed  j  and  there 
must  be,  indeed,  a  rather  bestial  concupiscence  in  the  man 
to  ask  the  marital  debt  at  such  a  time.  Certainly,  the  wife 
will  not  ask  for  it  during  the  first  few  weeks,  unless  incited 
by  a  morbid  affection  {nympliomania  piierperalis).  If,  in 
all  this,  there  is  not  enough  to  satisfy  a  healthy  conscience 
that  the  thing  in  question  is  forbidden,  then  more  emphasis 
must  be  given  to  the  fact  that  the  act,  at  this  period,  is  in 
the  highest  degree  injurious  to  the  wife.  The  danger  is 
the  greater  in  proportion  to  the  smallness  of  the  interval 
that  separates  the  act  from  the  delivery.  The  lying-in 
period  leads  to  a  great  many  affections  which  are  then, 
indeed,  simply  physiological,  but  which  would  be  considered 
morbid  at  any  other  time.  The  reconstruction  of  the 
enlarged  uterus  requires  a  greatly  heightened  activity  of  the 
organism ;  nay,  according  to  more  recent  investigations,  a 
total  absorption  and  renovation  of  the  same  takes  place. 
The  processes  in  the  generative  organs  directed  toward  this 
end,  and  the  changes  and  lesions  caused  by  gestation  and 
parturition,  of  themselves  afford  a  predisposition  to  various 
disorders :  such  as  floodings,  inflammations,  changes  of 
position.  That  the  direct  local  irritation  incident  to  the 
act,  and  even  the  general  excitement  caused  by  it,  cannot 
but  be  injurious,  is  indisputable.    The  danger  is  the  greater. 


COPULA  TEMPORE   LACTATIONIS.  109 

as  the  time  is  nearer  to  delivery.  The  processes  mentioned 
above  are  of  greatest  energy  during  the  first  two  weeks. 
At  this  time,  also,  the  prostration  of  the  female's  strength 
is  greatest.  After  this,  the  danger  becomes  less  ;  but  ex- 
perience proves  sufficiently  that  the  slightest  injury  may 
have  the  worst  consequences,  so  long  as  the  generative 
organs  have  not  returned  to  their  normal  condition.  Now, 
the  uterus  does  not  return  to  its  normal  state  before 
the  expiration  of  six  weeks.*  At  this  time,  again,  the 
menses  reappear,  if  the  woman  does  not  suckle  (in  women 
giving  suck  they  delay  longer),  and  the  organism  gives  the 
signal  that  it  is  prepared  for  a  new  generation. 

For  the  reasons  stated,  I  regard  the  copula  as  absolutely 
forbidden  during  the  first  two  weeks  after  delivery,  as  it 
then  may  be  very  injurious  to  the  wife.  Even  during  the 
following  four  weeks,  1  do  not  regard  it  as  allowable  gen- 
erally. But  the  moralists  must  decide  what  reasons  will 
suffice  to  counterbalance  the  danger  of  serious  injury  to  the 
wife,  which,  although  lessened,  remains  still  imminent. 


c. — Tempus  Lactationis, 

^^  Tempore  lactationis  conjugio  uti  licere  communissime 
(auctores)  affirmant;  turn  quia  periculum  inficiendi  lac,  et 
sic  nocendi  prolij  rarum  est;  turn  quia  lex  nulla  id  vetat.^^ 
(Scavini,  1.  c,  tom.  iv,  573.)  The  opinion  that  there  is 
danger  of  infection  to  the  milk  is  no  longer  held,  at  least 
in  so  far  as  any  deterioration  of  the  milk  can  be  affirmed 
to  result  directly  from  cohabitatio.     But  it  is  a  different 

■^  "  The  womb,"  says  Schroeder  (1.  c,  pa^.  208),  "weighs,  immediately  after 
delivery,  two  pounds  ;  one  week  later,  only  one  pound ;  after  two  weeks,  only 
fib.;  and  it  returns  to  its  normal  size,  so  far  it  does  so  at  all,  only  after 
some  six  weeks.'* 


110  THE    SIXTH    COMMANDMENT. 

thing  whether  the  copula  might  not  be  rendered  apparently 
forbidden  at  this  period  by  the  fact^  that  the  milk  grows 
thinner  and  deteriorates  as  soon  as  pregnancy  supervenes, 
whereby  the  suckling  child  may  be  seriously  injured. 
Generally  the  milk  will  even  totally  disappear.  Then 
artificial  nutrition  becomes  necessary,  which  is  always  less 
safe  than  nutrition  by  the  mother's  milk.  Some  moralists 
forbid  the  copula  in  this  case  :  '^  Quia  non  licet  sihi  con- 
sulere  cum  damno  innocentisJ^  (Lig.,  lib.  vi,  911.)  They 
must,  at  least,  take  for  granted  that  the  wife  knows  from 
experience  that  she  does  conceive  during  lactation,  where- 
in generally  conception  does  not  take  place.  I  accede  to 
the  opinion  of  Sanchez,  who  holds  the  copula  allowable, 
according  to  Liguori  (ibidem) :  ^^  Quod  tunc  vel  alia  via  ipse 
{pater  seu  mater)  poter it proli  consulercj  vel  eritjusta  causa, 
ipsam  (prolem)  periculo  exponendi,  ne  tamdiu  conjuges 
cogantur  abstinere  cum  tanta  difficultate.^^ 


d. — Tempus  Fraegnatlonis, 

Copula  during  pregnancy,  according  to  the  common 
view  of  the  moralists,  is  at  least  not  a  mortal  sin  so  long 
as  there  is  no  danger  of  abortion,  and,  according  to  a  great 
many  authors,  not  even  a  venial  one.  Liguori  (1.  c,  924) 
says :  ^'  Caeteriim  miJii  arridet  sententia,  quod  coitus  cum 
praegnante  non  possit  excusari  a  cidpa  veniali,  nisi  adsit 
periculum  incontinentiaCy  vel  alia  honesta  causa ^''^  but  Gury 
adds,  and  I  think  correctly  :  ^^  Quae  [honesta  causa)  vix  alio- 
quin  unqimm  ahesse  potest ^^  (1.  c,  torn  ii,  pag.  906). 

The  point  in  question,  therefore,  is  the  danger  of  abor- 
tion. It  must  be  said,  in  general,  that  copula  may  in- 
directly cause  abortion,  through  irritation  and  hy perse mia 


COPULA  TEMPORE  PRAEGXATIONIS.        Ill 

of  the  uterus,  only  when  occurring  with  excessive  fre- 
quency or  violence.  But  even  then  the  danger  is  only 
greater  during  the  first  months  of  pregnancy.  If  the 
generative  organs  are  otherwise  healthy,  such  a  hyper- 
iemia  may  cause  the  escape  of  the  ovum  most  easily  in 
the  first  few  days  after  conception.  It  may  be  that,  dur- 
ing this  period  of  pregnancy,  very  many  ova  perish,  per- 
haps, in  consequence  of  copula.  Very  often  they  are  not 
noticed,  because  generally  they  then  escape  easily,  and 
without  unusual  flooding.  But,  during  this  very  period, 
the  copula  cannot  be  forbidden,  for  no  one  can  tell,  at 
least  with  certainty,  when  pregnancy  has  taken  place. 
The  more  remote  from  the  day  of  conception,  the  less  is 
the  danger  of  an  abortion  in  consequence  of  copula,  if  the 
organs  are  healthy.  The,  alas !  too  frequent  accident  of 
abortion  takes  place  in  a  far  less  degree  from  any  direct 
external  cause*  than  spontaneously,  in  consequence  of 
morbid  affections  of  the  foetus  and  its  decaying,  or  of 
morbid  conditions  of  the  womb  or  of  the  whole  organism 
of  the  pregnant  woman.  A  full,  plethoric  habit,  anasmia 
and  chlorosis,  acute  febrile  affections  of  various  kinds,  in- 
flammations and  chronic  congestion  of  blood  in  the  womb, 

*  Unless  the  pregnant  woman  acts  without  any  consideration  of  her  con- 
dition. All  movements  and  actions,  that  either  cause  violent  shaking  of 
the  body,  or  bring  on  stronger  contraction  of  the  abdominal  muscles,  should 
he  avoided  by  her.  Of  the  first  class  (in  my  opinion  entirely  forbidden  to 
the  pregnant  woman)  are:  leaping,  dancing,  viz.,  round  dances  (for  the 
figure-dances,  quadrilles,  are  nowadays  walked,  and  are  not  injurious), 
riding  on  horseback.  Also  riding  over  rough  roads  should  be  avoided  as 
much  as  possible.  Even  riding  in  railroad  cars  does  not  seldom  cause  abor- 
tion, in  consequence  of  the  continuous  shaking  movement;  and,  therefore,  a 
long  raih'oad  ride  should  not  be  undertaken  without  necessity.  According 
to  my  experience,  the  concussion  communicated  from  the  sewing-machine, 
through  the  legs,  directly  and  principally  to^  the  abdomen,  does  often  pro- 
duce aborti(m.  If  not  absolutely  necessary  for  support,  the  use  of  sewing- 
machines  should  be  avoided.  A  hand-sewing-machine  is  to  be  pivterred. 
Although  not  so  efficient  as  the  other,  its  use  has  neither  of  those  evil  conse- 
quences named,  uor  others. 


112  THE    SIXTH    COMMANDMENT. 

caused  either  bj  local  or  general  disorder, — all  of  these 
seem  to  predispose  a  female  to  miscarriage.  It  is  certain 
that  there  is  predisposition  to  miscarriage  for  which  no 
cause  is  apparent,  when  it  must  be  ascribed  to  a  morbidly 
exalted  irritability  of  the  woman  otherwise  in  health.  If 
such  predisposition  exist^  a  trivial  cause  may  bring  on 
abortion.  Circumstances,  which  otherwise  would  have  no 
evil  influences  over  pregnant  women,  precipitate  the  cata- 
strophe under  such  circumstances ;  for  instance,  any  vivid 
emotions,  fear,  joy,  sensual  excitement,  spirituous  liquors 
in  small  quantities,  warm  foot-baths,  a  slip  of  the  foot,  a 
perhaps  slight  fall,  riding  in  a  carriage  or  railroad  car, 
lifting  of  small  weights,  and  finally  copula, — any  one  of  these 
is  capable  of  bringing  on  abortion.  The  prevalence  of  mis- 
carriage t  shows  that  such  a  predisposition  is  very  common, 
especially  in  the  cities.  When  such  a  predisposition  exists, 
the  copula  is  not  a  necessary  cause  of  abortion  j  but  the 
danger  thereof  cannot  be  set  aside,  especially  if  the  copula 
occurs  with  excessive  frequency  and  violence.  But  it 
must  not  be  overlooked  that  such  predisposition  is  not 
known,  unless  either  such  a  morbid  affection  of  the  wife 
as  is  generally  conducive  to  it  has  been  proved  by  medical 

The  abdominal  muscles  are  strongly  exercised  by  the  lifting  of  heavy 
weights,  and  by  high-reaching  for  things.  A  pregnant  woman  doing  such 
things  without  necessity  is  very  blamable,  and  grievously  sins,  in  my 
opinion,  if  she  is  well  enough  instructed  about  the  probable  consequences, 
and  nevertheless  persists  in  that  way  of  acting.  Even  wilfully  straining 
the  abdomifial  muscles  at  constipation,  which  often  occurs  during  pregnancy, 
may  have  evil  consequences,  and  should  be  avoided  as  much  as  possible. 
Simple  clysters  of  water,  dietetic  means,  and  mild  purgatives,  such  as  com- 
potes, fresh  fruit,  buttermilk,  or  castor  oil,  breast-powder  (pulvis  liquirl- 
tiae  compositus),  magnesia,  etc.,  should  be  used  :  but  drastic  purgatives, 
which  generally  contain  aloes,  must  be  forbidden. 

Excesses  in  the  use  of  spirituous  liquors  are  always  hurtful;  but  to  the 
foetus,  during  the  first  months,  they  may  even  bring  death.  Bleeding  can 
be  also  a  cause  of  abortion,  and  should  not  be  used  unless  by  special  order 
of  the  physician. 

t  Hegar  says,  Schroeder  assenting  (1.  c,  pag.  427).  that  there  is  one 
miscarriage  during  the  first  months  to  ti-10  deliveries  at  the  full  terai. 


COPULA   TEMPORE   MORBI.  113 

examination,  or  the  wife  has  repeatedly  miscarried  without 
any  known  external,  vehemently  exciting  cause.  If  the 
predisposition  is  proved  in  the  one  or  the  other  way,  copula, 
I  should  think,  is  not  allowable;  for  there  exists  an  increased 
possibility,  or  rather  a  certain  probability,  of  the  danger 
of  abortion.  Nevertheless.  I  would  look  upon  it  as  a  venial 
sin,  because  the  danger  is  not  so  very  great  as  that  it  may 
not  be  counterbalanced  by  grave  reasons,  as,  for  instance, 
danger  of  incontinence.  Such  married  people  should  by 
all  means  be  counselled  to  be  moderate  ad  numerum  et 
ad  modum. 


e, — Tempus  Morhi, 

Here,  of  course,  diseases,  contagious  and  not  contagious, 
must  be  separately  considered. 

Among  contagious  diseases  I  single  out  syphilis  {morbus 
gallicus  of  the  moralists),  because,  in  its  baneful  conse- 
quences, it  stands  alone  amongst  diseases. 

Syphilis  is  a  disease  of  so  grave  and  frightful  a  nature, 
and  at  the  same  time  of  so  Ignominious  a  character,  that 
I  regard  the  copula  during'its  presence  as  always  forbidden, 
even  although  only  one  of  the  married  people  suffer  from 
it.  The  danger  of  the  infection  of  the  healthy  person 
through  copula  is  so  imminent  as  to  leave  scarcely  a  chance 
of  escape.  The  demand  for  the  copula,  on  the  part  of  the 
diseased,  becomes  a  horrid  outrage  upon  the  healthy  part- 
ner ;  and  it  is  more  than  charitas,  it  is  even  insanity,  in  ray 
opinion,  on  the  part  of  the  healthy  party,  to  undergo  the 
almost  certainty  of  becoming  infected  with  such  a  disease. 
I  cannot  even  admit  the  danger  of  incontinence  as  a  right 
cause.     This  may  seem  too  severe  ;  but  every  one  who  has 


114  THE    SIXTH    COMMANDMENT. 

had  experience  of  the  terrible  consequences  of  this  formid- 
able disease  will  agree  with  me.  I  believe  on  this  point 
there  exists  an  unanimous  accord  amongst  physicians. 

Moreover,  e^en  the  offspring  of  such  a  copula  is  tainted, 
inasmuch  as  the  parents  almost  invariably  transmit  this 
complaint  to  their  children ;  frequently  abortion  sets  in, 
and  even  the  children  who  reach  their  full  term  often  perish 
in  a  terrible  manner  during  their  first  months  of  life. 
Thousands  of  children, — and,  alas  !  how  often  without 
baptism  ! — have  thus  to  bear  the  penalty  of  the  sins  of  their 
fathers. 

With  other  contagious  diseases  it  may  be  otherwise. 
The  moralists  distinguish  between  diseases  of  long  duration 
(chronic  diseases,  among  which  they  also  class  syphilis  !) 
and  such  as  may  soon  terminate  fatally.  Regarding 
the  first  class,  they  say  that  copula  asked  for  with  good 
reason  cannot  be  refused.  I  agree,  as  far  as  the  sick  party 
is  concerned  ;  but,  on  the  part  of  the  healthy  person,  I  think 
it  holds  good  only  in  cases  where  the  disease  is  not  very 
troublesome,  and  not  of  a  tendency  to  shorten  life  consider- 
ably. This  latter  case  is  of  rare  occurrence.  I  may  here 
mention  that  phthisis,  which  the  moralists  class  among 
contagious  diseases,  is  not  contagious.  To  the  objection 
that  phthisis  is  hereditary,  and  that  the  progeny  of  parents, 
tainted  with  this  complaint,  are  at  least  exposed  to  a  prox- 
imate danger,  St.  Thomas  answers:  "  Qiiamv  is  proles  g'uf- 
7ierctur  infirma^  tamen  melms  est  ci  sic  esse,  quam  penittis 
non  esseJ^  (Lig.,  lib.  vi,  915.) 

In  contagious  diseases  such  as  may  soon  and  easily  lead 
to  death,  the  moralists  regard  the  copula  as  forbidden ;  at 
least,  that  there  is  no  obligation  on  the  part  of  the  healthy 
party  to  grant  it.  This  opinion  is  certainly  supported 
by  every  physician.     The  healthy  party  cannot  even  be 


COPULA   TEMPORE   MOPvBf.  115 

allowed  to  ask  for  the  marital  act;  ^^  cum  nemo  sit  dominus 
suae  vitae  aut  salutisJ^ 

In  diseases  not  contagious,  two  distinctions  should  be 
kept  in  view.  For  here,  indeed,  it  is  a  question  of  no  mean 
significance  whether  the  disease  be  of  a  slight  character, 
and  one  which  does  not  seriously  impair  the  strength  ;  or 
whether  the  disorder  be  very  weakening  and  painful,  and 
accompanied  with  strong  fever.  Furthermore,  there  may 
arise  the  danger  of  abortion  to  the  impregnated  ovum,  or, 
again,  the  injury  may  be  limited  to  the  parents. 

With  regard  to  the  danger  of  abortion,  in  consequence 
of  copula  with  a  diseased  mother,  I  refer  to  what  is  said 
under  the  head  tempus  praegnationis.  I  may  add  that 
also  many  acute  diseases,  especially  those  accompanied  by 
violent  fevers,  easily  lead  to  miscarriage  :  consequently, 
whilst  such  diseases  last,  there  exists  a  predisposition  to 
abortion.  A  not  contagious  disease  of  the  father  has  no 
influence  at  all  through  copula  as  causing  miscarriage. 
With  regard  to  the  injury  that  may  arise  to  the  parents, 
it  is  clear  that  diseases  of  a  mild  and  undepressing  nature 
do  not  suffer  considerable  aggravation  from  copula.  Since 
here  any  serious  aggravation  is  not  to  be  feared,  the  copula, 
it  seems,  is  allowed  in  such  cases,  and  cannot  be  refused 
rightly.  Exception  must  be  made  in  diseases  of  the  genera- 
tive organs,  which  are  always  of  importance,  although  they 
may  often  appear  trivial  to  men  outside  the  profession  ;  for, 
especially  in  females,  they  may  be  prolonged  and  made  worse 
by  the  copula.  These  chronic  disorders  of  the  female  organs 
are  very  frequent,  and  rather  difficult  to  cure.  If  trifling 
in  the  beginning,  and  easy  of  cure,  they  may  be  made 
worse  by  the  continued  practice  of  copula.  A  physician 
should  therefore  be  always  consulted,  and  the  patient  should 
be  strictly  enjoined  to  obey  his  directions  to  the  letter. 


116  THE   SIXTH   COMMANDMENT. 

With  regard  to  more  serious  diseases,  there  are  some  in 
which  no  serious  injury  is  to  be  feared  from  a  moderate 
use  of  cohabitation.  Among  such  I  place  phthisis.  Phthisical 
people  may  always  suffer  somewhat  froui  copula,  but  not  to 
any  great  extent,  unless  they  are  predisposed  to  discharges 
of  blood  by  coughing  and  hemorrhage,  or  that  they  are 
troubled  with  great  difficulty  of  breathing.  Such  people 
generally  have  the  sexual  instinct  unusually  strong,  and 
they  should  be  counselled  to  be  moderate.  Again,  within 
this  same  category  are  included  external  surgical  affections, 
unless  there  be  fear  of  bleeding  from  a  wound  in  con- 
sequence of  the  irritation.  But  copula  must  be  regarded 
as  always  injurious,  and  perhaps  as  leading  to  serious 
damage,  even  to  sudden  death,  in  febrile  diseases,  especially 
in  acute  inflammatory  affections  of  the  organs  within  the 
abdominal  cavity  (peritonitis) ;  or  within  the  chest  (pneu- 
monia, pleuritis,  pericarditis);  or  within  the  skull  (menin- 
gitis, hypersemia,  or  cerebral  congestion)  ;  likewise  among 
chronic  disorders,  in  diseases  of  the  heart,  in  dropsy,  when 
there  is  considerable  shortness  of  breath.  In  such  cases, 
I  think,  the  copula  should  neither  be  asked  for  nor  granted, 
before  the  physician  has  been  consulted.  Whether  the 
copula  here  be  a  venial  or  a  mortal  sin  depends  upon  the 
.  answer  of  the  physician  and  the  circumstances  of  the  case. 
If,  for  instance,  the  doctor  says  there  is  danger  of  sudden 
death  inter  aut  statim  post  copidam,  I  think  it  is  surely  a 
mortal  sin.     The  moralists,  of  course,  must  decide  this  point. 

/.•  —Temptis  Statim  post  Balneum,  vel  Sectionem  Venae,  vel 
Frandium  aut  Coenam, 

I  make  particular  mention  of  these  circumstances,  because 
the  moralists  say  that  the  copula  after  taking  a  bath  or 


TACTUS   ET   ASPECTUS   TMPUDICI.  117 

after  venesection  is  not  allowed,  as  then  involving  consider- 
able danger.  For  the  time  after  the  bath,  the  existence  of 
any  danger  must  be  entirely  denied,  at  least  for  persons 
otherwise  healthy;  and,  after  bloodletting  by  venesection, 
it  exists  only  in  so  far  as  either  the  bandage  might  be 
slackened,  and,  consequently,  violent  bleeding  ensue,  or  as 
the  withdrawing  of  blood  were  so  great  that  the  irritation  of 
the  copula  might  cause  a  dangerous  fainting-fit.  Generally 
the  danger  will  not  be  great ;  and,  again,  these  cases  are  very 
rare.  After  dinner  no  serious  injury  is  to  be  feared  for 
persons  otherwise  healthy. 

After  the  use  of  spirituous  liquors  to  a  considerable  de- 
gree, it  is  different.  There  is  scarcely  a  doubt  that  children 
generated  in  drunkenness  are  exposed  to  the  danger  of 
becoming  mentally  weak,  or  even  idiotic,  or  deaf  and  dumb. 
Hence  the  decision  is  correct,  that  the  sober  party  is  not 
obliged  to  admit  of,  or  to  render,  the  marital  duty.  The 
moralists,  as  their  ground  for  this  decision,  place  drunken 
persons  in  the  same  list  with  the  insane.  Certainly,  the  in- 
jury that  may  result  to  the  child, — which  injuiy,  unhappily 
must  be  also  feared  for  the  offspring  of  the  insane, — goes 
far  to  support  the  argument  of  the  moralists. 


IV.— TACTUS  ET  ASPECTUS  IMPUDICL 

Although,  according  to  the  moralists,  the  female  is  not 
bound,  ^'•nec  etiam  ad  vitam  sibi  servandam  nudam  se 
ocidis  et  manibus  chirurgi  subjicerej'-^  yet  it  is  certain,  on 

*This  sententia  certa  of  the  moralists  cannot  be  disputed  with  regard  to 
women,  married  or  single,  who  need  have  no  care  for  others.  But  it  may 
be  a  different  thing  with  women  who  have  duties  toward  tliird  persons,  for 
instance :  In  the  care  of  their  families,  the  education  of  their  children^  the 
support  and  tending  of  aged  parents.     Apart  from  the  eircimistance  that 


118  THE   SIXTH   COMMANDMENT. 

the  other  hand^  tliat  neither  tactus  et  aspectus  nor  sermones 
et  lectiojies  wipiidicae  are  sinful,  if  there  exists  for  them 
causa  necessaria,  vel  utilis,  vel  conveniens  animae  aut 
corpori.  This  is  also  sure  that  the  pollution  that  may  fol- 
low, even  if  foreseen,  is  not  sinful  as  long  as  no  consent  is 
given.  In  this  all  moralists  agree  unanimously,  and  it 
would  be  sad,  indeed,  for  priests  and  physicians  as  well,  if 
it  were  otherwise;  for,  they  could  not  otherwise  exercise 
their  duties  in  many  cases  with  safe  consciences.  The  ad- 
vice on  the  part  of  the  priest  inter  confessionem,  and  the 
aspectus  and  tactus  in  medical  practice,  are,  unhappily, 
often  such,  that  reflective,  as  I  would  style  them,  carnal 
emotions  are  sure  to  follow ;  or,  otherwise,  the  priest  and 
the  physician  must  be  made  of  wood  or  stone. 

"Prae  ocuUs  tamen  liabenda  est  limitation '-  says  Ballerini, 
(Gury,  1.  c,  tom.  i,  pag.  398,  note),  ^'  quam  ex  communi 
sententia  St.  Alplionsiis  apponit  ^  dummodo  ahsit  periculum 
consensus  J  in  pravos  scilicet  mot  us  suhortamque  delecta- 
timiemy 

There  is,  nowadays,  in  medical  practice  an  entirely 
new  and  very  special  objective  method  of  examination 
employed,  which  necessitates  often er  than  formerly  the 
direct  application  of  the  senses  of  sight,  hearing,  and  touchy 
to  the  naked  body.  Suah  a  xqyj  special  objective  exami- 
nation of  the  body  must  be  said  not  only  to  be  beneficial, 
but  also  necessary,  at  least  in  general.  Denudations  and 
touches  cannot  be  avoided  thereby.  But  it  may  be 
questioned  whether  there  has  not  grown  up  a  rather  lax 
practice  on  the  part  of  physicians,  by  making  unnecessary 
examinations    requiring    indecent    denudations,   and  by 

the  reprigiiance  will  be  more  easily  overcome  in  such  cases,  the  duty  of 
preserving  health  and  life  will  be  tlie  more  apparent  from  those  duties 
toward  others,  so  much  so  that  tactus  ct  aspectus  impudici  of  absolute  neces- 
Bity  cannot  be  refused  without  sin. 


TACTUS   ET   ASPECTUS    IMPUDICI.  119 

making  necessary  ones  with  rather  more  than  necessary 
indecency.  This  is  a  matter  of  conscience  with  the  physi- 
cian, as  is  likewise  the  prevention  of  consent  to  inordinate 
emotions.  Besides^  he  should  consider  that  it  is  his  duty 
to  spare  the  modesty  and  conscience  of  his  patients,  in 
whom  his  manipulations  may  arouse  carnal  emotions,  as 
well  as  in  himself. 

The  rule,  therefore,  must  be,  that  touches,  as  well  as 
denudations  of  the  partes  minus  Jionesfae  { pectus ^  hrachia, 
crura)  and  of  the  partes  tiirpes  [partes  genitales  Usque  proxi- 
mae),  should  be  made  only  when  they  appear  of  benefit  or 
of  necessity  to  find  out  and  cure  a  disorder.  In  this  matter 
I  am  by  no  means  inclined  to  think  that  physicians  are 
alone  guilty  of  such  unnecessary  examinations  j  but  I  will 
mention  the  fact  that  females  themselves  often  try,  either 
directly  or  indirectly,  to  induce  such  examinations.  Not 
only  are  hysterical  females  guilty  of  this  indecency,  but 
other  female  patients  also  try  to  have  these  unnecessary 
examinations  made,  incited  by  culpable  concupiscence,  just 
as  often  as,  and  even  oftener  than,  physicians  make  them 
from  erotic  motives.  Through  custom,  physicians  become 
hardened  against  irritatio  ex  tactu  et  aspectu.  Thus  they 
do  not  seek  them,  ceteris  paribus,  to  the  same  extent  as 
others  would  under  similar  circumstances  ;  nor  will  they 
experience  carnal  emotions  at  times  at  which  men  outside 
of  the  profession  would  be  exposed  to  great  danger.  This 
is  especially  the  case  when  such  examinations  and  manipu- 
lations are  really  necessary.  Apart  from  the  grace  of 
vocation,  it  is  certain  and  easy  of  comprehension  that  the 
attention  paid  to  the  disease  and  its  symptoms,  the  exertion 
of  the  senses  and  of  the  whole  activity  of  the  mind  required 
for  scientific  examination  and  treatment,  are  in  themselves 
apt  to  diminish  the  danger  of  inordinate  emotions,  and  still 


120  THE   SIXTH   COMMANDMENT. 

more  the  danger  of  consenting.  The  best  safeguard  of  the 
physician,  therefore,  against  sins  of  this  kind  is  to  make 
such  manipulations  and  denudations  only  when  they  are 
really  of  necessity.  At  the  same  time,  his  good  name  will 
be  better  protected,  if  he  is  rather  too  cautious  than  too 
lax.  Finally,  the  modesty  and  conscience  of  his  patients  are 
then  best  respected.  For,  necessary  examinations  and 
denudations  are  almost  always  submitted  to  by  the  patient 
and  then  with  safe  conscience.  A  female  who  possesses 
decency  and  modesty  will  become  indignant  if  she  sees  that 
her  body  is  unnecessarily  subjected  to  touches  and  looks ; 
but  perhaps  sensations  and  a  delectation  are  brought  on,  the 
sinfulness  of  which  must  be  imputed  to  the  unprincipled 
physician. 

In  case  a  female  tries,  from  an  erotic  concupiscence,  to 
induce  such  manipulations  on  her  body,  then  his  own  good 
sense  must  tell  the  physician  whether  he  should  seem  not 
to  notice  this  inclination,  or  whether  he  should  refuse  it 
with  outspoken  authority. 

Perhaps  the  best  means  to  save  the  good  name  and 
conscience  of  the  physician,  as  well  as  of  the  patient,  is, 
if  possible,  to  make  manipulations  of  the  partes  turpes  or 
minus  Jionestae  only  before  witnesses.  Either  husband, 
mother,  sister,  or  a  relative,  or  a  nurse,  should  be  present. 
It  will  be  easy  for  the  physician  to  find  a  pretext  that  will 
cover  the  real  object  of  having  some  one  present,  rather 
than  be  left  alone  with  the  patient.  The  presence  of  a 
witness  is  a  protection  against  bad  tongues,  against  un- 
necessary acts,  and,  even  in  necessary  ones,  against  the 
rise  of  inordinate  emotions,  and  the  consent  to  them.  A 
decent  woman  will  feel  grateful  for  such  precautions,  and 
a  lewd  one  will  be  thus  restrained. 

Here  I  would  especially  warn  physicians  against  chloro- 


TACTUS   ET   ASPECTUS    IMPUDICI.  121 

forming  without  witnesses  ;  for  just  here  the  danger  of  ill- 
repute  and  of  delectation  increases  of  the  latter^  at  least 
for  the  physician.  The  danger  which  accompanies  nar- 
cosis gives  him  a  good  pretext  for  not  inducing  it  without 
assistance.  I  know  of  a  case  wherein  a  person  illegitimately 
pregnant  asserted  herself  to  have  been  the  victim  of  the 
physician  during  a  narcotization.  Counter-proof  being 
impossible,  the  good  name  of  an  imprudent  and,  perhaps, 
innocent  physician  may  be  lost. 

Here  I  may  mention  an  experiment  of  our  own  days, 
in  order  to  lay  it  before  the  moralists  for  decision,  viz.: 
attempts  to  impregnate  human  females  artificially.  Such 
experiments  have  been  made  by  some  physicians,*  in  cases 
where,  the  copula  and  semen  being  normal,  impregnation 
would  not  take  place,  because  the  semen  could  not  reach 
the  uterus,  or  could  not  be  retained  in  the  vagina.  The 
semen,  in  such  cases,  was  drawn  by  the  physician  into  a 
fine  syringe  from  the  vagina  statim  post  copulamj  and  was 
then  directly  injected  into  the  womb.  Sims  asserts  that 
he  effected  impregnation  in  this  manner  once.  From  a 
medical  standpoint,  much  could  be  said  regarding  this 
assertion.  It  is  the  only  success  that  has  been  claimed  for 
such  experiments  on  human  subjects ;  although  they  have 
been  successful  on  animals,  especially  on  frogs  and  dogs. 
From  a  moral  standpoint,  I  am  not  yet  prepared  to  give 
an  opinion  on  this  matter. 

In  view  of  the  tactus  et  aspeckis  necnon  sermoncs  im- 
piidlciy  which  ar^  unavoidable  in  the  practice  of  medicine,  it 
has  often  been  a  matter  of  dispute  whether  female  physicians 
should  not  rather  be  employed.  There  is  something  at- 
tractive in  this  ;  but,  at  the  same  time,  there  result  so  many 

*  Among  others,  bj  Dr.  J.  Marion  Sims,  in  New  York,  and  Dr.  George 
Harley,  in  London. 

6 


122  THE   SIXTH    COMMANDMENT. 

inconveniences  when  females  act  as  physicians,  that  they 
have  been  admitted  to  the  whole  medical  practice  only  in 
a  few  exceptional  cases.  Even  midwives,  during  whose 
functions  the  necessity  for  such  confidences  mostly  occur, 
are  more  and  more  refused  by  women  themselves,  and 
physicians  are  called  in,  in  preference.  There  may  be 
reasons  for  this  of  convenience  and  confidence,  etc. ;  but 
the  fact  proves,  at  least,  that  less  repugnance  to  necessary 
examinations  and  manipulations  by  the  physician  is  felt 
even  by  decent  women  than  would  be  a  priori  expected. 
I  by  no  means  approve  of  the  fact  that,  nowadays,  even 
in  normal  labors,  the  assistance  of  a  physician  is  often 
demanded,  where  the  help  of  a  midwife  is  sufficient.  But  I 
can  very  well  understand  how  a  woman,  who  approaches 
a  very  critical  period  of  her  life,  should  desire  that  help 
which  inspires  her  with  the  most  confidence.  If  we  had 
women  of  the  higher  classes  of  society  to  assist  at  childbirth 
in  an  always  decent  manner,  after  having  thoroughly  acquired 
the  necessary  scientific  information^  I  have  no  doubt  but 
that  they  would  be  preferred.  But  as  midwives,  in 
Germany  at  least,  are  little  more  than  nurses,  we  cannot 
expect  that  women,  at  least  of  the  cultivated  classes,  will 
place  full  confidence  in  them  in  such  difficult  situations. 


C— THE  COMMANDMENTS  OP  THE  CHURCH. 

Of  these,  only  two,  viz.,  that  of  hearing  Mass  on  Sundays 
and  holidays,  and  that  of  fasting  and  abstaining,  need  be 
commented  on. 


I.— OBLIGATION  OF  HEARING  MASS. 

The  moralists  are,  indeed,  not  rigorous  as  to  what  reasons 
may  excuse  from  the  obligation  of  hearing  Mass.  Their 
maxim  is,  ^'  Excusat  a  Missa  audienda  quaevis  causa  medio- 
criter  gravis^  sen  quae  involvit  notabile  incommodiim  vel 
damnum  in  bonis  animae  vel  corporis  proprii  vel  proximi.^^ 
Thus  encouraged,  I  want  to  make  some  remarks  on  the 
excuse,  ^'I  cannot  stand  the  church-air."  I  speak,  of 
course,  only  of  such  as  derive  this  excuse  from  consider- 
ations of  health :  such  as  cannot  endure  "  church-air"  for 
other  reasons, — and  nowadays  their  name  is  legion, — do 
not  concern  us. 

But  what  makes  church-air  different  from  the  air  of 
other  places  ?  The  frequent  concourse  of  many  people, 
burning  of  tapers,  incense,  and  so  on,  no  doubt  contami- 
nate the  air  in  churches.  As  ventilation,  unhappily,  is 
generally  defective,  the  church-air  undergoes,  from  these 
causes,  a  peculiar  change,  which  sometimes  unpleasantly 
affects  the  olfactory  organs.  Besides,  during  service,  one 
is  surrounded  by  many  persons  w^th  whom  close  contact 
frequently  causes  disgust  and  nausea.  The  position  of 
kneeling  or  standing  is  a  tiresome  one  ;  the  dress  is  worn  as 


124       THE  COMMANDMENTS  OF  THE  CHURCH. 

on  the  street,  although  one  is  in  a  close  room,  etc.  Daring 
winter,  people  become  stiff  and  cold,  especially  if  there  is  a 
stone  floor ;  during  summer,  the  difference  from  the  tem- 
perature outside  is  often  great,  which  of  course  gives  rise 
to  unpleasant  affections  from  the  sudden  change.  There 
are,  therefore,  facts  enough  to  render  a  prolonged  stay  in 
church  somewhat  unpleasant,  and  at  times  pernicious  to  the 
bodily  welfare.  Anxiety,  shortness  of  breath,  faintings 
and  nervous  affections,  result  directly — colds  and  inflamma- 
tions, especially  of  the  respiratory  organs,  sometimes 
indirectly,  from  the  above-named  conditions.  One  need  not 
be  really  sick,  nevertheless,  some  physiological  affections 
tend  to  render  church-going  often  injurious  to  health. 

Persons  suffering  from  acute  diseases  are,  of  course, 
excused ;  and  the  obligation  also  clearly  ceases  in  many 
chronic  disorders.  It  is  doubtful  in  the  case  of  those  who 
otherwise  live  like  healthy  people,  but  who  cannot,  as 
they  say,  stand  church-air.  To  this  class  belong,  besides 
persons  suffering  from  general  debility,  all  those  whose 
nervous  system  is  enfeebled  or  over-irritated.  Hypochon- 
driacal and  hysterical  persons,  especially,  often  assert  their 
inability  to  go  to  church ;  and  I  think  they  should  be 
believed  as  long  as  there  is  no  foundation  to  suspect  that 
their  inability  arises  simply  from  religious  indifference, 
for  their  afflictions  are  not  merely  imaginary,  but  they 
are  real  diseases.  Such  persons  may  feel  very  well :  a 
hypochondriac,  for  instance,  in  a  crowded  club-room  full 
of  tobacco-smoke ;  a  hysterical  woman  in  the  heated  and 
packed  theatre, — but  as  soon  as  they  enter  the  church,  they 
feel  oppressed  and  have  a  fainting-fit.  If  this  is  oftener 
experienced  by  such  persons,  and  by  nervous  people  in 
general,  churcli-going  cannot  be  regarded  obligatory  for 
them,  but  must  be  left  to  their  discretion.     They  should 


CHURCH-GOING.  125 

be  counselled,  however,  to  try  again  from  time  to  time, 
and  then  rather  on  a  week-day  than  on  a  day  when  the 
church  is  crowded  with  people. 

Physiological  affections  wherein  similar  conditions  pre- 
vail, occur  in  women,  especially  during  the  period  of 
fecundity.  Tempus  menstruaUonis  et  laciationis  some- 
times, tempiis  gestationis  very  often,  predisposes  females 
to  the  above-named  attacks  while  in  church,  particularly 
so  during  the  first  and  last  months.  The  higher  classes 
of  society  are  certainly  too  lenient  in  this  point ;  but  too 
great  severity,  on  the  other  hand,  is  to  be  avoided  on 
account  of  the  child.  If  a  pregnant  woman,  of  otherwise 
rational  behavior,  has  for  several  times  experienced  ill 
consequences  from  church-going,  I  would  forbid  her  going, 
for  some  time  at  least^  although  I  am  fully  aware  how 
much  women  in  this  interesting  situation  need  the  consola- 
tions of  religion  and  prayer.  By  rational  behavior,  I  mean 
a  reasonable  way  of  dressing,  without  pressure  or  over- 
loading, but  with  due  protection,  especially  of  the  feet, 
against  wet  and  cold.  She  should  avoid  the  early  morning 
hours  as  well  as  the  latest  Mass,  when  the  church-air  is 
most  impure ;  she  should  not  go  with  an  empty  stomach, 
nor  with  an  overloaded  one,  nor  stand,  much  less  kneel, 
for  any  length  of  time ;  she  should  rather  sit  down,  it 
possible,  and  occasionally  change  her  position,  etc.  If  all 
this  is  of  no  avail,  if  attacks  of  anxiety  or  faintings  continue, 
the  pregnant  woman  must  leave  off  church-going  for  a  time : 
a  new  trial  may  be  made  after  some  weeks.  It  is  very 
seldom  that  a  woman  is  exposed  to  such  affections  during 
the  whole  period  of  ber  pregnancy. 

I  may  mention  here  that,  in  some  places,  people  think 
that  a  woman,  after  childbearing,  should  make  her  first 
walk  to  church  j  and,  also,  that  an  invalid  or  convalescent, 


126      THE  COMMANDMENTS  OF  THE  CHURCH. 

wlien  first  allowed  to  leave  the  house,  is  under  the  obligation 
of  going  immediately  to  church.  Gury  (1.  c,  torn,  i,  pag. 
346)  says,  with  Liguori :  ^'  Excusantur  aegroti,  mjirniij 
convalescentes,  qiiibus  nocet  foras  prodire.^^  From  this  the 
conclusion  should  not  be  made  that  all  those  quibiis  non 
nocetforas  prodire  are  under  obligation  of  hearing  Mass. 
It  is  clear  from  my  remarks  that  it  is  not  at  all  the  same 
thing  to  send  one  from  the  room  into  the  fresh  air,  and 
to  send  her  or  him  to  church.  My  practice  was  always 
not  to  allow  women  after  delivery,  or  convalescents,  to  go 
first  to  church  ;  but  to  order  them  to  take,  first,  a  few 
walks  in  the  fresh  air.  Many  infirm  persons  may  likewise 
be  ordered  to  take  some  exercise  in  tlie  fresh  air,  but  for- 
bidden to  go  to  church.  Such  persons,  of  course,  sliould 
not  take  their  walk  at  the  time  of  divine  service,  lest  they 
give  scandal;  or,  if  local  conditions  require  it,  they  should 
stay  entirely  in  the  house  on  days  on  which  it  would  be  ot 
obligation  for  them  to  hear  Mass,  if  not  hindered  by  a  suf- 
ficient cause. 

I  thought  it  desirable  to  mention  these  particulars,  in 
order  to  enable  priests  to  pass  judgment  on  the  above- 
named  affections  and  circumstances,  although  the  mora- 
lists say  all  such  people  should  follow  the  advice  of  the 
physician. 

II.— FASTING. 
With  regard  to  fasting,  likewise,  medical  advice  should 
be  followed ;  but,  as  the  moralists  say,  medici  rellgiosi  et 
timorati  consulendi  suiit,  si  facile  fieri  potest  In  the  case 
of  persons  who  are  actually  sick,  this  is  all  well  enough  ; 
but,  in  the  case  of  those  who  are  not  exactly  sick,  and 
who  cannot  claim  any  other  excuse  from  the  obligation 
of  fasting,  the  physician  may  be  at  a  loss  how  to  advise 


FASTING.  127 

quite  as  much  as  the  priest.  Healthy  people  must  know 
themselves  whether  they  can  fast  or  not.  If  such  people 
ask  the  physician,  as  they  sometimes  do,  only  for  the 
purpose  of  shifting  responsibility  upon  other  shoulders, 
whether  they  are  bound  to  fast,  he  should  conscientiously 
answer.  You  are  the  best  judge  of  that  yourself.  But  it 
is  unnecessary  to  speak  here  of  the  necessity  of  physicians 
acting  conscientiously  in  this  matter  5  for  those  who  are 
concerned,  do  not  read  this  book,  and  those  who  read  it, 
know  themselves  what  they  have  to  do.  This  much  is 
certain,  the  preacher  was  right  who  said :  ^^I  am  convinced 
that,  during  the  three  days  of  the  Carnival,  there  are 
many  more  of  those  who  become  sick  from  too  much  food, 
than  there  are  of  those  who  suffer  prejudice  to  strength 
or  health  from  too  little  nourishment  throughout  the  whole 
time  of  Lent." 

The  following  are  the  causae  excusantes  a  jejunio  as 
ttated  by  the  moralists  : — 

1.  Dispensatio  su])erioris^  of  the  pope,  the  bishop  of 
the  diocese ;  by  custom,  also,  of  the  parish-priest  and  the 
confessor.  The  physician  cannot  grant  dispensation,  but 
he  decides  only  whether  one  cannot,  or  should  not,  fast 
for  medical  reasons.  '•''Ad  ipsos  (sc.  medicos)  non  pertinety 
nisi  declarare  (conscientiose  tameny  ne  aliorum  pteccatis 
graventur)^  quaenam  sit  causa  vere  sufficiensJ^  (Scavini, 
L  c,  torn,  i,  pag.  285.) 

2.  Impotentia  physica.  Sick  persons  and  convales- 
cents, women  with  child  or  giving  suck,  the  poor  who 
have  no  regular  sufficient  meals,  are  exempted  from  the 
law  of  fasting. 

3.  Impotentia  moralis.  Such  as  suffer  through  fasting, 
violent  headache,  vertigo,  etc. ;  soldiers  in  the  camp  or  in 
barracks;    women  who    are   forbidden    to    fast  by   their 


128  THE    C03IMAXDMENTS    OF   THE    CHURCII. 

husbandsj  and  who  might  suffer  very  grave  inconveniences 
by  disobedience  j  mariti,  qui  jejunantes  omnino  nequeiint 
deblhim  uxoribiis  solvere  ;  yoting  people  under  the  age  of 
twenty-one  j  feeble  old  people^  the  age  being  fixed  by 
most  of  the  moralists  at  the  sixtieth  year  of  life  for  men, 
and  by  many  at  the  fiftieth  year  for  women : — all  these 
can  consider  themselves  exempt  from  the  obligation  of 
fasting. 

4.  Labor  tunc  liberate  cum  sit  talis,  ut  sine  notabili 
corporis  defatigatione  excrceri  non  possit.  People  whose 
state  of  life  subjects  them  to  hard  bodily  labor  j  also  those 
who  make  difficult  journeys  on  foot^  or  on  horseback,  or 
by  carriage,  are  excused  j  servants  are  nearly  always 
exempted. 

5.  Pietas.  Troublesome  and  exacting  works  of  charity 
(spiritual  or  bodily),  assisting  the  sick  in  hospitals,  con- 
tinued hearing  of  confessions,  the  offices  of  preachers,  even 
of  judges,  physicians,  lawyers,  teachers,  may,  under  certain 
circumstances,  excuse  from  fasting. 

I  have  very  little  to  add  from  a  physician^s  standpoint 
to  these  excusing  causes.  I  would  include  women,  not 
only  during  the  period  of  gestation  and  lactation,  but  also 
of  menstruation.  For,  during  this  time,  the  female  organ- 
ism is  so  much  affected  by  the  phenomena  occurring  in 
the  genital  apparatus,  the  nervous  system  often  suffering 
at  the  same  time,  that  there  is  sufficient  reason  not  only 
to  deprecate  any  deprivation  of  food,  but  to  forbid  such 
directly.  This  one  included,  all  reasonable  demands  are 
met.  Such  as  cannot  appeal  to  any  of  these  excusing 
causes  stated  above,  should  not  importune  the  physician  or 
the  priest  in  order  to  be  exempted ;  for  they  wiil  not  fast, 
and  they,  and  they  alone,  must  bear  the  responsibility. 

There  are  some  cases,  oftener  met  with  in  praxis,  where 


FASTING.  129 

some  doubts  occur  to  me  as  to  the  decisions  of  the  moralists, 
Liquidum  non  frangit  jejimium,  is  an  axiom  of  the  mor- 
alists. Drinks,  therefore,  are  allowed  daring  the  fast,  but 
those  only  that  are  used  ut  simplices  potiones.  Of  these 
are,  as  all  agree :  sugar- water,  lemonade,  coffee,  tea,  pro- 
vided that  the  addition  of  sugar  is  not  so  great  as  to  make 
the  thing  rather  a,pulmentiim  than  a  drink.  Beer  and  wine 
are  also  allowable.  '^  Aliter  esset  de  sumptione  lactis^  jus- 
culij  sued  pomorum  [vulgo  melons),  et  aliorum  fructixum^ 
item  uvarum  confectarum  aut  tunc  dentihus  pressarum, 
licet  postea  exspuantur.  Nam  liaec  omnia  censentur  ha- 
here  rationem  cihi,  et  potiiis  ad  nutritionemj  quam  ad  cibi 
vehiculum  referunturJ^  (Scavini,  torn,  i,  pag.  279.)  Gmy, 
following  Liguori,  says  (1.  c,  torn,  i,  pag.  454) :  ^^Fer 
liquidum  autem  id  solum  intelligitur^  quod  ex  communi 
Vi?>Vi  sumitur  per  modum  potus,  non  vero  per  modum  cihiy 
ut  laCj  etc."  I  have  doubts  about  milk,  as  opposed  to 
chocolate,  which  all  moralists  allow  (of  course  when  pre- 
pared with  water,  not  with  milk) :  "  Uncia  cum  dimidia 
chocolatl  in  cyathis  ordinariis/^  is  put  down  as  the  allowed 
measure.  One  ounce  and  a  half,  that  is  about  forty-five 
grammes  to  a  cup,  makes  a  beverage  which  is  about  equal 
to  a  cup  of  milk  in  nutritive  value,  and  surpasses  milk  in 
satisfying  the  feeling  of  hunger.*  Does  custom  suffice  to 
render,  of  two  things  that  have  the  same  effect,  one  allowed 
and  the  other  forbidden  ?  Besides,  chocolate  is  oftener 
than  milk  taken  per  modum  cibi  (in  the  di-y  state,  namely) ; 
milk  is  a  real,  although  nutritive,  drink,  and  is  often  used 
as  a  means  of  quenching  thirst,  or  of  preparing  food  (as 
vehiculum    cihi)A     City   and  country  in  this  case  would 

*  Of  chocolate,  the  whole  solid  substance  is  taken  ;  of  coffee,  the  infusion 
only:  chocolate  and  coffee,  therefore,  cannot  be  put  into  the  same  category. 

t  As  drink,  for  instance,  instead  of  coffee;  as  vehiculum  for  preparing 
chocolate. 


130      THE  COMMANDMENTS  OF  THE  CHURCH. 

receive  unequal  treatment  j  for,  in  the  country,  milk  is  a 
very  handy  drink,  and  more  in  use  than  chocolate  *,  so 
much  so,  that  the  latter  is  certainly  not  regarded  as  simple- 
drink,  while  the  former  is  looked  upon  as  such.  The  only 
real  difference  in  favor  of  chocolate  is  the  circumstance 
that  milk  comes  from  flesh.  This,  perhaps,  wa?  the  primi- 
tive cause  of  forbidding  milk  j  but  it  is  now  no  longer 
forbidden  on  that  score,  so  far  as  I  can  ascertain.  Since 
the  ancient  rule  of  fasting  has  been  relaxed,  in  many 
countries,  with  regard  to  things  that  come  from  flesh  (such 
as  eggs,  butter,  etc.),  I  do  not  see,  for  the  reasons  given, 
why  one  should  not  be  allowed  just  as  well  to  take  a  cup 
of  milk  as  a  cup  of  chocolate  (prepared  of  45  grammes  of 
dry  chocolate).  The  bull  of  Clement  XIII  (1759),  quoted 
by  Scavini  (1.  c,  tom.  i,  pag.  280),  forbids  all  drinks  mixed 
with  milk.  The  prohibition  of  milk  therefore  was  absolute 
in  former  times,  but  nowadays  nobody  doubts  that  the 
adding  of  milk  to  coffee  or  tea,  as  is  commonly  done,  is 
not  forbidden  on  fast-days. 

I  may  mention  another  view  of  the  moralists.  Eight 
ounces  of  bread  are  pronounced  to  be  allowed  for  the 
collation  at  night.  ^'  Licet  sumere  in  coenida  panem  cunt 
aqua  et  oleo  decoctum.  .  .  .  Attamen  jiixta  S.  Lig.  non  licet 
sumere  octo  imcias  panis  decocti  cum  aqua,  hac  praecisa, 
Hatio  est,  quia  panis  per  decoctionem  ct  fermentationem 
cum  aqua  aliam  naturam  acquirit,  ita  id  ex  eis  quid  unutn 
fiat,  et  evadat  una  substantia  tnajor.  Concedi  aidem 
potest,  ait  S.  Liguorius,  id  inter  ipsam  refectionem  quis 
panem  aqua  aid  vino  intingat  et  sic  etiam  octo  uncias  panis 
vino  madefacii  sumat,  quippe  nidla  hie  intervenit  fermen- 
tatio ;  et  liquor,  cum  inserviat  tantum  ad  vehiculum,  non 
compidatury  (Gury,  1.  c,  tom.  i,  pag.  460.)  Scavini  (1.  c, 
i,  pag.  283)  likewise  declares  the  boiling  of  the  bread  in 


ABSTINENCE,  131 

water  not  allowed :  '^  Nam  ita  consuhstantiatitr  cum  aqua 
ut  non  ampUus  possit  separari^  imde  esset  quid  et  magis 
nutriens  et  excedens  quantitatem. "  A  certain  chemical 
change  of  bread,  when  boiled  in  water  (independent  of  the 
addition  of  any  fatty  matters  ),  need  not  be  entirely  denied  ; 
but  this  change  must  be  considered  as  the  beginning  of 
digestion,  for  it  is  the  same  as  that  effected  by  the  begin- 
ning of  digestion.  The  nutritive  value  is  not  increased 
thereby.  The  quantity  of  such  a  bread-soup  may  perhaps 
cause  a  fuller  sensation  of  satiety  than  the  relative  quantity 
of  bread  in  the  dry  state.  But  even  this  difference  will 
not  be  very  great.  Apart  from  the  addition  of  fatty 
matters,  I  do  not  see  any  difference  whether  the  bread  is 
boiled  in  water  or  wine,  or  whether  those  fluids  only  serve 
to  soften  and  soak  the  bread. 

This  is  a  matter  of  little  importance  ( in  Germany  or  in 
America ) ;  for,  as  to  the  quality  of  articles  of  food  allowed 
at  collation,  the  ancient  rule  of  fasting  has  been  greatly 
relaxed.* 

in.— ABSTINENCE. 

The  rule  of  abstinence,  in  ancient  practice,  was  to  ab- 
stain from  flesh  and  all  white-meats,  that  come  from  flesh 
(lacticinia  et  ova).  At  present,  the  rule  is  to  abstain  from 
the  flesh  of  animals  that  live  on  land,  and  have  respiration 
t  terra  nascent ium  et  respirantium). 


*  The  obiection  is  made  to  me  that  the  material  nutritive  value  is  not  alonp 
to  be  considered.  For,  it  is  said  that  food  added  to  drink  in  a  relatively 
small  quantity,  in  order  to  temper  the  drink  partakes  of  the  nature  of  drink, 
and  becomes  a  part  of  the  drink.  Fice  versa,  a  drink,  for  instance  even 
water,  used  to  temper  food,  assumes  the  character  of  food,  becomes  itself 
food.  According  to  this  view,  my  remarks  on  milk  (which  is,  indeed,  a  food 
under  the  form  of  drink  )  and  on  chocolate,  would  have  to  be  modified. 
But  as  I  have  not  yet  raa(ie  up  my  mind  on  this  point,  I  have  left  the  text 
of  former  editions  as  it  stood. 


132  THE    COMMANDMENTS   OF   THE    CHURCH. 

Besides  fish,  "  according  to  the  common  acceptation  of 
the  faithful  and  of  the  learned,  and  by  legitimate  custom" 
as  well,  it  is  considered  allowable  to  take  :  hcusfae  (grass- 
hoppers. Celsius  and  Pliny  knew  of  a  locusta  which  is 
certainly  a  sea- animal,  a  crustacean  or  a  crab :  which 
is  meant?  Both  will  do.) — Imacae  (snails),  testudines 
(tortoise),  cammari  (lobster),  cancri  (crabs),  ranae  (frogs), 
conchae  (crustaceans).  '^  Idem  dicendtim  est  (Scavini,  1.  c, 
tom.  i,  pag.  271)  de  lutris  (otter),  castoribus,  fihris  (castor, 
beaver),  et  aliis  quae  piscibus  comparantur.'^^  This  remark 
on  otters  and  beavers  I  cannot  approve  of,  for  their  whole 
''  similarity  to  fish  "  consists  in  this,  that  they  live  partly 
in  water,  in  order  to  obtain  food :  they  are  true  mammals, 
and  have  red,  warm  blood.  If  these  external  criteria  are 
worth  consideration,  then  those  of  the  above-named  animals 
that  do  not  live  in  water,  juid  do  not  even  hunt  for  their 
food  in  it  (such  as  land-tortoises,*  land-snails), — these,  I 
say,  should  fall  under  the  rule  of  abstinence,  to  be  con- 
sistent. Also  all  water-fowl  should  be  counted  as  animals 
similar  to  fish  j  but  these  are  explicitly  excluded  by  Scavini 
(1.  c,  pag.  272).t 

Amongst  causes  for  dispensation,  I,  from  a  medical 
standpoint,  think  only  one  well  founded,  namely :  if  the 
body  cannot  obtain  its  necessary  nourishment  without  flesh- 
meat. 

Those  alimentary  substances  that  are  principally  con- 
tained in  flesh-meat  can  be  replaced  by  other  articles  of 
food,  apart  from  fish  and  the  other  animals  named  above. 
I  will  not  enter  here  into  any  discussion  as  to  what  other 
nourishing    materials    may    become    substitutes    for    the 

*  Turtles  (those  on  land,  also)  are,  scientifically,  true  ampliibia,  with  red, 
cold  blood.     The  abode,  water  or  land,  does  not  give  a  scientific  criterion. 
"    t  Caviare  is  neither  flesli  nor  fish  ;  it  is  a  food  prepared  from  the  roes  of 
large  fish  (fish-eggs).  When  eggs  are  allowed,  it  is  not  forbidden. 


ABSTINENCE.  133 

albuminoid  materials  that  are  principally  in  question ;  nor 
will  I  name  any  articles  of  food  containing  these  albuminoid 
substances  in  so  small  a  proportion  that  they  can  only 
replace  flesh-meat  when  taken  in  large  quantities.  I  omit 
even  milk,  although  it  is  the  sovereign  food  of  all  young 
mammals  and  of  infants  j  for  herein,  and  to  the  end,  many 
objections  of  greater  or  less  weight  could  be  made.  I 
may  mention  only  one  substitute  that  contains  these  albumi- 
noid substances  (and  fatty  matters)  in  a  small  bulk,  and  in 
an  easily  digestible  form,  but  in  a  large  proportion, — eggs. 
One  hen-egg  of  medium  size  and  of  50  grammes  (without 
shell)  contains,  the  water  deducted,  about  as  much  albumen 
as  50  grammes  of  good  beef.  Two  eggs  may  therefore  be 
considered  as  equal  in  nutritive  power  to  100  grammes 
of  good  beef  (without  sinews  and  fibres).  Moreover,  the 
fat  of  the  yolk  is  not  reckoned  in  this  calculation,  although 
it  is  present  in  an  easily  digestible  form,  and  is  of  no  small 
nutritive  value,  It  is  evident  that  eggs  are  a  first-class 
substitute  for  flesh-meat.  They  were  probably  for  this 
reason  forbidden  by  the  ancient  rules  of  abstinence. 

Besides,  it  is  a  well-known  fact  that  those  with  whose 
stomach  fish,  and  such  kinds  of  food,  do  not  agree,  in 
general  easily  digest  eggs  and  food  prepared  therefrom, 
if  the  latter  be  not  impaired  in  digestibility  by  the  mode 
of  preparation. 

Hence  cases  will  seldom  occur  wherein  abstinence  from 
flesh-meat  will  do  harm  (apart  from  the  cases  of  really  sick 
persons,  and  of  those  who  are  convalescent  after  grave 
diseases).  I  think,  then,  that  strictness  in  this  one  point  of 
abstinence  is  to  be  recommended,  while,  in  regard  to  fast- 
ing, the  discipline  should  be  of  a  milder  character.  Gury, 
following  Liguori,  says  (1.  c,  tom.  i,  page  452) :  "Proper 
caution   should   be   observed    in    granting    dispensation 


134  THE  COMxMANDMENTS   OF   THE   CHURCH. 

to  those  who  importune  the  priest  for  dispensation  from 
the  law  of  abstinence,  and  who  pretend  that  they  cannot 
digest  the  foods  allowed."  Scavini,  after  stating  that 
"women  with  child  or  giving  suck  are  allowed  to  eat  meat 
on  days  of  abstinence,  adds  correctly:  '^  Si  proles  aegrotet 
aut  mater  sit  valde  debilis.^^  I  want  to  make  all  reasonable 
exceptions  for  women  *,  but  gestation  and  lactation  are  in 
themselves  no  sufficient  cause  for  granting  dispensation. 
Unless  the  conditions  required  by  Scavini  exist,  abstinence 
can  be  observed  without  any  harm  to  either  mother  or  child. 
The  so-called  "  longings"  of  pregnant  women  deserve  no 
attention.  Other  people  also  frequently  take  a  fancy  to 
meat  on  days  of  abstinence — sometimes  even  people  who 
regard  fish  a  delicacy  on  other  days.  Nitimur  in  vetitum. 
If  a  pregnant  woman  really  has  a  disgust  and  an  insur- 
mountable dislike  for  the  substitutes  of  flesh-meat,  it  is 
difi'erent ;  and  in  such  cases  the  physician  should  be  con- 
sulted. But  I  protest  against  the  view  that  makes  those 
above-named  conditions  current  and  generally  valid  causes 
for  dispensation  from  abstinence  for  otherwise  healthy 
women. 

In  addition  to  fasting  and  abstinence,  there  are  other 
mortifications,  which  are  not  obligatory,  but  are  of  practice 
among  some.  The  most  common  are  :  penitential  cinctures 
(cilicium,  catenellae),  discipline,  protracted  vigils,  etc.  The 
penitential  cinctures  are  made  of  twisted  horsehair,  of 
coarse,  bristly  wool,  or  of  fine  wire.  The  sharp  points 
of  the  material  irritate  and  scratch  the  skin  *,  besides, 
knots  are  made  in  these  cinctures.  Other  cinctures  are 
more  like  chains,  and  are  of  thicker  wire,  brass  or  iron : 
the  latter  kind  is  considered  by  Liguori  (^^  Vera  sposa  di 
Gesu  Cristd'^)  less  hurtful  than  the  former.  An  unreasonable 
using  of  the  above  may  do  serious  harm  in  two  directions. 


ABSTINENCE.  185 

Either  the  pressure  of  the  cincture,  if  continually  worn 
too  tight,  may  lead  to  injuries  to  that  part  of  the  body 
around  which  they  are  tied  ;  as,  for  instance,  cinctures 
around  the  waist  may  lead  to  stoppages  in  the  abdometi  j 
or  belts  around  the  limbs  (arms,  thighs,  shoulders),  to 
swellings  and  lameness  ;  or,  again,  these  cinctures  may  be- 
come injurious,  inasmuch  as  through  their  friction  and  local 
pressure  on  the  skin  they  cause  inflammations,  and  even 
deep  ulcers.  Such  inflammations  may  become  chronic  and 
of  a  malignant  character  (cancerous).  I  think,  therefore, 
that  penitential  cinctures  should  not  be  allowed  to  be  worn 
continually,  but  only  for  a  time — say  for  some  hours  dur- 
ing the  day,  or  for  one  or  two  days  during  the  week.  The 
points  and  edges  must  be  coarse,  but  should  not  be  too 
sharp.  Cinctures,  therefore,  of  fine  twisted  wire  with  sharp 
ends  should  not  be  tolerated  j  finally,  cinctures  must  not 
be  bound  too  tight. 

The  use  of  the  discipline  may  prove  injurious  by  causing 
wounds  which  may  become  chronic  ulcers,  if  flagellation 
is  persisted  in  before  the  wounds  are  healed.  Also, 
violent  flagellation  with  a  heavy  discipline  on  soft  parts 
may  cause  lesion  to  the  inner  organs.  The  discipline, 
therefore,  should  not  have  sharp  edges,  and  it  should  be 
applied  only  on  the  back  (the  soft  parts  near  the  loins 
excluded),  and,  perhaps,  on  the  shoulders  and  arms ; 
especially  the  discipline  must  never  reach  the  region  of  the 
private  parts,  any  part  of  the  abdomen,  or  the  breast  of 
females. 

Long  vigils  are  not  practised  so  much  for  mortification's 
sake  as  formerly,  because  in  our  times  there  is  a  general 
inclination  to  shorten  as  much  as  possible  the  time  of  rest, 
in  order  to  gain  time  for  labor.  Staying  awake,  if  beyond 
bounds,  may  prove  very  injurious,  for  sleep  is  a  period 


136      THE  COMMANDMENTS  OF  THE  CHURCH. 

of  necessary  repose  in  the  system.  During  sleep  there 
is  a  suspension  of  mental  and  of  muscular  voluntary 
activity,  whilst  the  vegetative  activity  of  the  organism 
continues,  and  thus  replaces  the  material  wasted  by  men- 
tal or  bodily  exertion.  Through  want  of  sleep  the  whole 
organism  suffers ;  general  debility,  emaciation,  hectic 
fever,  are  the  consequences ;  but  most  generally  the 
nervous  system  is  affected.  A  habitual  deficiency  of  sleep 
produces  headache,  numbness,  dulness,  dislike  particu- 
larly for  mental  work,  and,  if  the  warning  be  not  seasonably 
heeded,  a  general  over-irritation  of  the  nervous  system  : 
illusions  and  hallucinations,  even  complete  insanity,  may 
follow  such  a  perversion  of  the  natural  order  of  things.  I 
think  therefore  that,  in  general,  excessive  wakefulness 
should  not  be  allowed.  Most  men  require  about  seven 
hours  of  sleep,  and  this  amount  cannot  be  materially  di- 
minished without  injury  to  health.  One  may,  from  time 
to  time,  take  off  a  little  from  this  allowance,  but  it  should 
not  be  done  habitually.  I  do  not  know  why  St.  Alphonse 
(1.  c.)  thinks  less  sleep  is  required  for  women  than  for  men, 
and  that  "  five,  or  at  most  six,  hours  are  sufficient  for 
women."  My  opinion  is  that  they  require  just  as  much 
sleep  as  men  do.  Whether  the  amount  of  sleep  be  taken 
in  one  continuous  sleep,  or  at  separate  times,  may  in 
itself  be  indifferent  f  but  I  may  remark,  here,  that  taking 
off  from  the  necessary  time  of  repose  is  less  injurious  in 
the  morning  than  at  night ;  and  that  late  night-hours  are 
the  more  likely  to  result  in  evil  consequences. 


D  — THE  8ACKAMENT8. 


I.-_OF  BAPTISM. 

•  Not  unfrequently  does  tlie  occasion  present  itself  when 
the  physician  must  be  the  minister  of  the  sacrament  of 
baptism  :  as,  for  instance^  when  a  new-born  infant  is  in 
danger  of  death^  or  when  the  case  is  one  of  premature 
delivery.  Sometimes  this  duty  may  become  obligatory, 
at  least,  ex  cha^itate.  What  is  needful  to  be  known  in 
such  cases  of  necessity  will  be  given  here  ;  and  also  such 
matters  will  be  treated  of  as  in  themselves  are  subjects 
of  doubt  to  theologians,  and  must  have  their  explanation 
in  physiology  and  pathology. 

For  the  validity  of  baptism  are  required  the  proper 
matter  (materia  romota  necnon  proxima),  the  proper  form, 
intention  of  the  minister,  and  the  proper  subject  of  the 
sacrament. 

The  only  valid  matter  is  natural  water  (materia  remota 
est  aqua  naturalis  sen  elementaris,  apta  ad  ahluendum). 
If  possible,  the  water  should  be  blessed.  Materia  valida 
is,  according  to  the  moralists  :*  aqua  fontiunij  fluminisj 
mai'isj  stagnoruntj  paludum^  lacnum,  cisternarum ;  aqua 
resoluta  ex  glacie,  nive  vel  grand ine ;   aqua  sidphurea  vel 

mineralis  /  aqua  coUecta  ex  t^apore^  rorc,  vel  cffluens  tem- 
pore nimboso  ex  pariete,  foViiSj  etc.  /  aqua  turhida,  mixta 

*  Gury,  torn,  ii^  pag.  155. 


138  THE    SACRAMENTS. 

cwn  alia  substantia,  modo  aqua  sit  materia  vere  et  certe 
praedomina7is,  ita  id  juxta  usum  ant  aestimatioiiem  liomi- 
num  adhuc  aqua  did  possit. 

Doubtful  matter :  jusculum  valde  tenue,  Uxiviumj  cere- 
visia  tenuis  (also  tea  and  coffee  ?),  aqua  ex  sale  soluto  (?)  ; 
humor  fluens  e  vite,  aliisque  plantis. 

Not  valida  materia  :  lac,  sanguis,  lacrimae,  sudor,  saliva 
sputum,  urina  (and  foetal  water) ;  vinum,  oleum,  cerevisia, 
jus  densum  ex  adipe,  etc.  ;  lutum,  atramentum,  nix,  glacies, 
pruina  et  alia  nondum  soluta, 

Certo  autem  peccat  graviter  peccato  sacrilegii,  qui  absque 
gravi  necessitate  utitur  aqua  impura,  turhida  et  faeculenta, 
licet  Jiaec  materia  sit  valida. 

Therefore,  if  physician  or  midwife  must  administer 
baptism,  they  are  obliged  suh  gravi  either  to  clean  their 
hands  as  much  as  possible  from  blood,  mucus,  faeces,  etc., — 
because,  otherwise,  they  may  easily  soil  the  water, — or  they 
must  pour  the  pure  water  by  means  of  a  vessel. 

If  valid  matter  be  not  at  hand,  it  is  allowed  in  danger 
of  death  to  use  a  doubtful  one,  adding  the  condition :  Si 
Jiaec  materia  sit  sufficiens. 

The  proximate  matter  is  the  ablution  or  washing,  either 
by  dipping  the  subject,  or  by  pouring  the  water  on  it, 
or  by  sprinkling  it  with  the  water.  One  ablution  suffices, 
but  generally  it  is  done  three  times,  as  prescribed  at  the 
solemn  administration  of  baptism.  If  there  is  time  enough, 
lay  persons,  in  cases  of  necessity,  should  go  through  the 
triple  infusion,  and,  if  possible,  make  the  same  in  the  sign 
ot  the  cross.  Reverence  for  this  important  act  requires 
this  much.  Sprinkling  is  sufficient  for  ablution.  But  it 
is  advisable,  especially  for  lay  people,  to  administer  the 
sacrament  always  per  modum  infusio7iis,  with  a  real  flow- 
ing of  the  water,  if  time  and  circumstances  allow.     The 


OF   BAPTISM.  139 

infusio  should  be  on  the  head,  if  possible,  and  on  a  place 
where  there  is  no  hair;  for  the  hair  might  prevent  the 
water  froir:  really  touching  the  skin,  although  it  is  generally 
not  very  strong  in  the  newly-born.  The  water  should, 
therefore,  either  be  poured  on  the  forehead,  or  may  be 
rubbed  on  the  head  during  the  infusion,  either  with  the 
hand  that  is  pouring,  or  with  the  other.  But  if  the  water 
cannot  be  poured  on  the  head,  and  if  baptism  cannot  be 
postponed  on  account  of  proximate  danger  of  death,  then 
it  is  sufficient  to  pour  it  on  the  breast,  shoulders,  arms, 
legs.  For  the  reason  that  this  baptism  is  not  of  sure 
validity,  it  must  be  afterward  repeated  conditionally.  If 
the  child  after  delivery  is  capable  of  life,  and  can  be 
brouglit  to  the  church,  the  priest  will  baptize  conditionally  ; 
otherwise,  if  proximate  danger  of  death  still  exists,  it  should 
be  again  baptized  conditionally  without  delay,  the  form 
being :  Si  non  es  baptwatus,  ego,  etc.  Can  a  child  validly 
be  baptized  in  the  womb,  if  there  is  certainty,  or  very 
great  danger,  of  its  death  before  delivery  ?  ^'  Affirmandimi 
probabilius,"  says  Gury  (tom.  i,  pag.  155),  "•  si  piier  in 
'utero  attingatur  aqua  aliquo  mediante  instrumento  ;  quia 
cum  infans  existat  jam  homo  viator ,  valide  potest  haptisari. 
Nee  obstat,  quod  puer  adJiuc  involuttts  sit  in  secundina, 
quia  haec  censentur  veluti  pars  infantis.  Sub  conditions 
tamen  baptisandus  est,  quia  non  constat  certOj  utrum 
baptismus  hac  ratione  collatiis  sit  validus^ 

I  cannot  admit,  according  to  the  progress  of  science  in 
the  knowledge  of  the  development  of  the  foetus,  that  the 
child  ^' involutus  in  secundina^^  may  be  baptized  validly, 
although  only  probabilius  so.  For,  the  fcetal  membrane, 
taken  as  a  whole,  is  by  no  means  a  part  of  the  child.  It  is 
composed  of  three  coats,  which  can  be  plainly  distinguished, 
and    even    separated.     The    two  inner   membranes   (the 


140  THE   SACRAMENTS. 

amnion  and  the  chorion)  might  be  looked  upon  as  a  part 
of  the  child's  body,  inasmuch  as  they  are  formed  by  the 
ovum  itself;  but  the  outer  membrane  (termed  decidua)^ 
being  a  product  of  the  uterus  alone,  is  certainly  a  part  of 
the  mother,  and  cannot  be  regarded  as  pars  infantis. 

If  any  part  of  the  child  can  be  reached  at  all,  it  will  be 
generally  possible  to  administer  the  sacrament  by  sprink- 
ling. A  small  rupture  of  the  fecial  memhraneSj  made 
artificially,  if  necessary,  will  allow  the  water  to  be 
injected  on  the  child  by  means  of  a  syringe.  If  this  be 
done,  one  hand  should  lead  the  syringe,  to  make  sure  of 
actual  contact  of  the  water  with  the  child's  body.  To  the 
objection  that,  in  danger  of  abortus,  or  premature  delivery^ 
the  introduction  of  the  syringe  with  the  hand  or  with  a 
finger  might  not  be  possible,  the  mouth  of  the  womb  being 
too  narrow, — I  may  answer  that,  in  such  cases,  we  have 
very  seldom  sure  indications  of  the  child's  life.  At  such 
an  early  period  of  delivery,  where  the  mouth  of  the  womb 
cannot  be  penetrated  by  the  finger  and  syringe,  there 
will  be  scarcely  ever  necessity  of  baptism.  Moreover, 
if,  in  such  a  case,  tlie  membranes  are  broken  too  soon,  and* 
the  water  allowed  to  flow  out  too  early,  the  delivery  might 
be  much  delayed,  thus  increasing  the  danger  to  the  chUd, 
and,  perhaps,  involving  the  life  of  the  mother.  I  remark 
this,  because  Gury  says :  "  Recentius  autem  medicorum 
peritia  aliam  methodum  invexitj  qua  certins  piier  nondum 
in  lucem  editus  hapti^ari  potest.  InvciitHni  ninnrum  est 
mstrumentunij  quo  secundina  disciiiditur ;  et  sic  aqua, 
alio  instrumento  adhibito,  ad  ipsum  foetus  corpus  immediate 
tangendum  pervenire  potest,''^  This  seems  to  have  re- 
ference to  the  above-named  cases,  where  the  bag  of  water 
is  fixed,  and  the  mouth  of  the  womb  undilated,  danger 
of  abortus  J  or  miscarriage,  existing.     I  would   earnestly 


OF  BAPTISM.  141 

protest  against  any  such  steps  being  taken  in  order  to 
baptize,  for  the  above  reasons.  It  is  very  seldom  possible, 
before  the  fifth  month,  to  be  certain  whether  the  foetus 
is  alive  or  not.  Therefore,  if  abortus  ensues  hefore  this 
time,  I  would  not  try  to  administer  baptism  by  the  use 
of  the  syringe.  I  would  proceed  in  the  manner  Gury 
mentions,  only  when  it  can  be  conclusively  assumed  that 
the  foetus  is  alive,  and  that  its  vital  power  is  declining. 
In  such  a  case  I  would  proceed  as  Gury  suggests,  even  if 
the  too  early  escape  of  the  water  might  probably  retard 
delivery.  The  disadvantage  to  be  feared  for  the  mother, 
and  the  hastening  of  the  child's  death,  cannot  here  be 
taken  into  consideration  in  comparison  with  the  necessary 
care  for  the  eternal  salvation  of  the  child.  Such  a  baptism 
is  always  doubtful,  because  there  is  very  little  security 
that  the  water  does  actually  touch  any  part  of  the  child, 
as  the  syringe  cannot  be  directed. 

If  a  syringe  cannot  be  had,  it  will  suffice,  in  case  of 
necessity,  to  wet  the  finger  with  water,  and  to  wash  a  part 
of  the  child's  body  with  this  wet  finger.  ^^  Dicimf  autmi 
oommimiter,  materiam  tunc  esse  certam,  si  haptizans  motu 
digiti  madefacti  partem  corporis  ahlueretJ^  (Gury,  tom.  i, 
pag.  157.)  Such  extreme  cases  will  be  very  seldom  met 
with  5  but  they  may  happen,  if  the  natural  passages  are  so 
narrow  that  the  presented  part  of  the  child  cannot  enter  the 
lower  strait,  and  that  the  child  cannot  be  delivered  alive. 
Likewise,  if  in  consequence  oi procidentia  of  the  umbilical 
cord  replacement  is  impossible,  and  if  the  pulsation  in  the 
cord  grows  weaker,  so  that  an  early  death  of  the  foetus 
must  be  feared,  the  presented  part  of  the  child  is  so  high  up 
that  it  can  be  reached  only  by  the  finger  or  by  the  syringe. 
To  baptize  on  the  umbilical  cord  I  would  not  regard  allow- 
able in  such  cases,  nor  as  valid,  because  this  is  only  a 


142  THE   SACRAMENTS. 

quasi-'psirt  of  the  child,  and  another  part  can  always  be 
reached. 

In  the  majority  of  cases  where  private  baptism  must  be 
administered,  one  or  or  more  parts  of  the  child  have  de- 
scended farther  down,  and  are  within  easier  reach ;  for 
instance^  when  there  is  a  presentation  of  the  smaller  ex- 
tremities as  the  feet,  after  turning  the  child,  before  it  is 
fully  extracted. 

Every  baptism  in  utero  must  be  repeated  suh  conditioner 
because  its  validity  is  only  probable.  The  same  applies 
if  baptism  be  administered  on  a  part  already  born,  with 
the  rest  of  the  body  not  yet  delivered,  except  in  the  case 
wherein  the  fully  delivered  head  is  baptized,  the  other 
parts  being  still  in  the  passage.  ^^  Nam  ut  liahet  Ritualej 
si  in/ans  caput  emiserit^  et  perictdum  mortis  immineaty 
haptizetur  in  capite  ;  ncc  postea  si  vivus  evaserit^  iterum  est 
haptizandus^  (Scavini,  L  c,  torn,  iii,  pag.  477.) 

The  form  of  baptism  is  :  "  Ego  te  haptizo'  in  nomine 
Patris  et  Filii  et  Spiritus  Sancti.^^^ 

The  words  of  the  form  must  not  be  changed,  and  nothing 
must  be  added.  The  words  must  be  pronounced  at  the  same 
time  that  the  water  is  poured  on  the  subject  baptized,  and 
this  likewise  by  the  same  person.  If  different  persons 
pronounce  the  words  and  pour  the  water,  there  is  no 
baptism  j  or,  again,  if  both  things  are  not  done  at  the  same 
time,  there  is  no  baptism. 

The  minister  of  baptism  mj^y  be  any  man  or  woman 
who  has  attained  the  use  of  reason,  even  an  infidel  or 
a  heretic.  In  a  case  of  private  baptism  it  must  be 
remembered  that  man  has  the  preference  over  woman ;  in 
other  words,  if  a  man  is  present  who  can  administer  bap- 
tism, he  should  be  the  one  to  do  it,  with  this  exception  :  ^^Si 
*  Without  Amen.  (S.  C.  R.,  June  9,  18530 


OF   BAPTISM.  14,^ 

pudoris  gratia  deceat  feminam  potius  quam  viriim  hapti- 
sare  infantem  non  omnino  editum  ;  vel  si  melius  femina  sciret 
formam  et  modum  haptisandi.''^  (Gruiy,  torn,  i,  pag.  159.) 
If  physician  and  midwife  are  present,  the  physician  should 
administer  baptism,  caeteris  paribus ;  if  he  is  not  present, 
the  midwife  ;  and  always  the  latter,  if  the  physician  him- 
self be  the  father  of  the  child.  For  the  Rituale  Rom.  says  : 
*^  Pater  aut  mater  prop>riam  prolem  haptisare  non  debent, 
praeterquam  in  mortis  articulo,  quando  alius  non  reperitur, 
qui  baptizet.'^''  * 

The  minister  of  baptism  must  also  have  the  intention 
of  conferring  the  sacrament,  or  at  least  of  doing  what  the 
Church  does  at  baptism. 

If  baptism  is  administered  conditionally,  the  condition 
must  be  pronounced  explicitly  :  ^'  Apponi  tamen  ore  debet, 
ubi  hoc  praescribit  Bubrica,  ut  in  baptismo  conditionato, 
praesertim  si  publice  conferatur,  ne  scilicet  adstantes 
credant  baptismum  absolute  iterariJ^  (Grury,  tom.  i,  pag, 
135.)  Therefore:  Si  non  es  baptisatuSj  si  etiam  vivis, 
ego,  etc. 

We  proceed  now  to  treat  some  matters  in  connection 
with  our  subject  as  find  their  explanation  in  physiology  and 
pathology,  for  instance,  monsters  and  double  formations. 

When  an  infant  is  in  danger  of  death,  any  one  may,  nay, 
even  is  bound  to,  baptize  immediately,  and  even  against 

*It  is  to  be  regretted  that  very  often  no  competent  person  is  to  be  hai 
when  the  case  is  most  urgent.  The  abortive  ova,  for  instance,  in  a  consider- 
able number  of  cases,  either  do  not  come  at  all,  or  else  they  come  too  late 
into  the  hands  of  competent  persons.  It  would  be,  certainly,  a  very  good 
thing  if  all  young  married  people  could  have  the  necessary  instruction  in 
this  matter.  But  who  will  give  it  f  The  priest  ?  He  can  Very  seldom  do 
BO.  The  physician  or  the  midwife?  They  generally  do  not  come  in  suc'i 
early  contact  with  young  married  people  as  to  give  the  necessary  infor- 
mation with  profit.  It  can,  therefore,  be  only  said  that  the  parish  priest, 
as  well  as  the  physician  and  midwife,  should  make  use  of  every  fit  occasion 
to  instruct  married  people  as  much  as  possible  concerning  this  matter.  I 
must  confesg  that  I  have  met  with  raidwives  who  possessed,  even  on  this 


144  THE   SACRAMENTS. 

the  will  of  the  parents,*  whose  consent  otherwise  would  be 
required  for  the  baptism  of  their  children  who  have  not 
attained  the  use  of  reason. 

-  Whether  a  lay  person  commits  a  mortal  sin  by  conferring 
private  baptism  whilst  in  a  state  of  sin  (viz.,  mortal  sin) 
is  answered  in  the  affirmative  by  some  moralists ;  in  the 
negative,  by  others.  St.  Alphonse  thinks  both  opinions 
probable,  although  inclining  to  the  former.  (Gury,  tom.  i, 
pag.  136.)  A  lay  person,  therefore,  is  not  obliged  to  make 
an  act  of  contrition  before  conferring  baptism.  The  bap- 
tism, however,  is  certainly  valid. 

Siihjectum  haptismi  est  omnis  et  solus  homo  vivus  nondum 
haptizatus.  For  our  purpose,  we  have  to  ask  in  regard  to 
a  substance  expelled  from  the  womb  : — 

1.  Is  the  substance  we  have  before  us  a  human  being! 

2.  Is  it  alive  ? 

Ad  1.  Doubts  as  to  whether  the  thing  brought  to  light 
be  a  human  being  might  have  had  place  in  former  times 
with  regard  to  abortive  ova,  and  they  may  now  arise  in 
cases  of  monsters.  Whether  abortive  ova  must  be  con- 
sidered human  beings  depends  solely  upon  the  circumstance 
whether  the  existence  of  a  foetus,  be  it  ever  so  small,  can  be 
ascertained  in  them.  If  the  foetus  is  found,  it  is  a  human 
being ;  for  we  consider  it  a  matter  of  fact  nowadays  that 
the  ovum  is  possessed  of  the  soul  at  the  very  moment  of 

point,  only  a  confused  and  deficient  knowledge,  because  they  had  received 
no  special  instruction.  The  pai'ish  priest  is  indeed  obliged  to  instruct  mid- 
wives  about  this  point.  But  as  the  latter  consider  themselves  as  competent 
persons,  which  they  are,  in  a  greater  or  less  degree,  such  instiiiction,  I 
think,  on  the  part  of  the  parish  priest  cannot  always  be  given  with  tlie 
necessary  authority.  For  this  reason  it  would  be  a  desirable  thing  if 
Chiistian  physicians  generally  would  take  on  thc-nist'lves,  when  occasion 
offers,  the  duty  of  conferring  with  the  mid  wives  of  their  districts  about 
these  questions,  and  of  explaining  and  instructing  them,  if  necessary. 

*  Compare  Benger,  "PastoralTheologie."  Regensburg:  G.  I.  anz,  1802^ 
torn,  ii,  pag.  473. 


OP   BAPTISM.  145 

conception.  If  no  foetus  is  discovered  in  the  expelled  ovum, 
as  is  not  unfrequentlj  the  case,  it  has  escaped  either  with  the 
blood,  or  else  it  has  decayed  and  has  been  absorbed  bj  the 
contents  of  the  ovum  :  a  thing  that  may  happen  during  the 
first  weeks  of  pregnancy.  After  the  third  week,  a  foetus 
may  be  known  as  such,  and  it  can  be  very-  easily  dis- 
tinguished at  the  end  of  the  first  month.  At  this  time 
the  embryo  is  one  centimeter  in  length,  that  is,  stretched 
out  (it  is  found  always  bent  together),  and  can  be  easily 
recognized. 

In  cases  of  monsters,  the  axiom  of  the  moralists  is 
certainly  correct,  to  wit :  that  a  substance  which  has  the 
form  of  a  human  head  and  of  a  human  chest  is  a  human 
being,  and  must  be  baptized.  For  a  foetus  that  has  head 
and  chest  possesses  separate  and  independent  life,  is  an 
individual  being.  It  is  still  more  accurate  to  say  that 
what  has  the  form  not  only  of  a  human  heady  but  of  a  head 
generally  and  chest,  must  be  characterized  as  a  human 
being.  Where  there  is  a  head,  it  is  always  a  human 
head,  although  it  may  be  deformed  by  defects  in  its  devel- 
opment. For  generation  between  man  and  beast  is  never 
effected;  and  St.  Alphonse,  indeed,  does  not  believe  in  it, 
though  he  nevertheless  speaks  of  this  kind  of  monstrosities 
in  relation  to  baptism.  There  occur  malformations  of  the 
head  which  impair  in  a  high  degree  its  appearance  as  a 
human  head ;  as,  for  instance,  the  so-called  hemicephalous 
and  anencephalous  foetuses,  where  either  the  facial  region 
is  strongly  developed,  or  the  cranial  part  and  its  contents 
are  more  or  less  deficient.  Although  these  beings  are  not 
capable  of  extra-uterine  life  and  nourishment,  they  arc 
most  certainly  human,  because,  absolutely,  they  can  be 
nothing  else.  Also,  very  noticeable  cleft-deformities  (such 
as  hare-lips;  or  deficient  velum  palatij  or  palatine  vault) 

7 


14:(>  THE    SACRAMENTS. 

may  to  a  very  considerable  degree  impair  the  liuman  ap- 
pearance, but,  nevertheless,  they  cannot  create  any  doubt 
as  to  humanity.  Therefore,  a  human  generation  which  has 
a  head  and  chest  is  a  human  being.  Head  without  chest, 
or  chest  without  head,  is  not  met  with  ;*  head  and  chest 
(and  abdomen)  without  extremities  occur.  There  is  an- 
other form  of  monstrosity  which  cannot  be  regarded  as  a 
separate  being,  although  it  has,  in  part,  rather  a  human 
form,  the  so-called  Acardiacus.  This  rare  monster  con- 
sists only  of  abdomen  and  legs.  ^'It  is  formedt  when, 
anastomosis  (junction)  taking  place  between  twins  lying 
in  one  chorion,  the  pressure  of  blood  in  one  of  them  pre- 
vails so  much,  that  the  circulation  (viz.,  of  the  blood) 
becomes  inverted  in  the  other,  in  consequence  of  which 
heart  and  langs,  together  with  a  part  of  the  trunk,  become 
atrophied  J  and  the  deformed  foetus  is  nourished  from  that 
which  is  normally  formed.'^  Such  a  foetus,  therefore,  does 
not  take  its  nourishment  from  the  mother  through  its  o\vn 
organs,  but  it  is  nourished  by  the  system  of  blood-vessels 
of  the  normal  foetus,  whose  system,  as  it  were,  extends 
itself  into  it.  Thus  it  is  nourished  as  an  appendix  to  the 
normal  foetus,  and  we  have  therefore  no  separate  life,  no 
individual,  no  human  being. 

Besides  what  are  called  monsters,  there  occur  a  great 
variety  of  double -formations,  wherein  doubts  may  arise 
whether  there  are  one  or  two  individual  beings.  Super- 
numerary parts,  of  course,  cannot  cause  these  doubts,  nor 
can  such  be  the  case  in  two  wholly  developed  bodies  which 
have  grown  together  in  some  way,  for  they  are  really  two 

*  Sometimes  rudiments  of  liead  are  met  with,  as  also  lumps  of  flesh  witli 
some  bones:  these  must  be  considered  as  totally  deformed  trunks.  Siuh 
wholesale  deformities  and  malformations  need  no  consideration  with  regard 
to  baptism. 

t  Schroeder,  C  Lehrhurh  der  Geburtikilfe.  Bonn,  at  Cohen  &  Sohn,  iv, 
Aufl.,  1874,  pag.  5U4. 


OF   BAPTISM.  147 

separate  individual  beings,  each  having  its  own  existence, 
though  accidentally  connected.  But  how,  if  we  have  one 
head  and.  two  trunks  ?  If  the  separation  exists  only  in 
the  lower  part  of  the  trunk,  there  being  only  one  heart 
and  one  pair  of  lungs,  I  would  consider  such  a  monster 
by  all  means  as  only  one  individual.  But  if  there  are  two 
hearts  and  two  sets  of  lungs,  or  at  least  two  hearts  (for,  to 
ascertain  the  lungs  during  life  may  be  very  difficult,  even 
impossible),  I  should  think  that  then  there  exist  two 
individual  beings ;  for  the  two  bodies  have,  indeed,  a 
common  central  nervous  system,  yet  each  one  possesses  a 
separate  vegetative  system,  and  may  consequently  live 
independent  of  the  other,  or  at  least  live  by  separate 
nourishing. 

Again,  monsters  present  themselves  that  have  the  head 
double,  and  only  one  trunk.  Even  if  the  trunk  be  only 
one  to  the  neck,  heart  and  lungs  included,  I  should  never- 
theless be  inclined  to  suppose  two  individual  beings  pres- 
ent. This  might  seem  contradictory,  because,  above,  I 
laid  stress  on  the  separate  vegetative  life.  But  I  did  so 
only  in  contrast  to  one  head.  Here  we  have  a  double 
central  nervous  system,  one  which,  if  not  directly  regarded 
as  the  seat  of  the  soul,  must  certainly  be  considered  the 
principal  organ  of  its  activity.  It  is  a  hard  tiling  to  be- 
lieve that  only  one  soul  exists  in  the  body  wherein  the 
organ  of  the  soul's  activity  is  twofold.  Besides,  it  has 
been  proved  by  observation  that,  oF  two  heads,  one  may 
sleep,  while  the  other  is  awake  ;  that  the  expression  of  one 
face  may  be  cheerful,  whilst  that  of  the  other  may  show 
languor  and  uneasiness.  These  phenomena,  of  themselves, 
only  prove  a  separate  sensitive  life  ;  yet  they  support  and 
strengthen  the  opinion,  that  we  have  to  suppose  two  souls 
where  there  exist  two  heads 


148  THE   SACRAMENTS. 

If  the  twofold  formation  is  not  limited  to  the  head,  but 
should  extend  itself  to  a  part  of  the  trunk,  the  matter 
would  be  the  same  so  long  as  there  is  no  double  formation 
of  the  heart  and  lungs,  or  at  least  of  the  heart.  But  if 
the  organs  within  the  cavity  of  the  chest  are  also  twofold, 
there  can  be  no  reasonable  doubt  that  we  have  before  us 
two  human  beings.  Head,  heart,  and  lungs  are  the  most 
important  central  organs  of  life, — of  separate  life.  If  nu- 
trition of  both  bodies  intra  iderum  and  extra  uterum  takes 
place  through  one  organ  {one  placenta  and  one  stomach), 
it  is  only  like  two  eating  out  of  one  vessel :  approjoriation 
of  aliment  takes  place  separately  in  each  body. 

Finally,  substances  are  expelled  from  the  uterus  of  the 
pregnant  human  female  which  contain  no  foetus,  and  which 
cannot  be  considered  as  foetuses :  the  so-called  moles. 
Moles  are  really  products  of  fruitful  association  5  they  are 
impregnated  ova,  in  which  the  foetus  has  decayed,  gener- 
ally very  early,  and  has  been  absorbed  or  dissolved,  the 
membranes  then  deforming  to  various  kinds  of  moles. 
They  may  be  small  or  large,  they  are  found  thickly  or 
thinly  covered,  they  are  sometimes  a  shapeless  mass  of 
flesh,  sometimes  more  solid,  or  they  may  consist  of  a  num- 
ber of  bags  full  of  fluid.  With  the  exception  of  these 
latter, — bag-moles  which  attain  often  a  very  large  size, — 
there  is  generally  found  a  small  cavity  filled  with  amniotic 
liquor,  hut  no  trace  of  a  foetus. 

Ad  2.  Does  the  human  being  live  ?  The  foetus  while 
in  the  womb  must  be  presumed  living,  unless  we  have 
certain  signs  of  its  death.  During  the  first  months  of 
pregnancy  we  have  no  other  sign  for  this  than  the  putrid 
quality  of  the  flow.  From  this  decomposition  of  the  fluids 
contained  in  the  uterus,  which  flow  out  if  abortion  sets 
in  (amniotic  liquor,  blood),  we  may  conclusively  presume 


OF   BAPTISM.  149 

tliat  the  child  is  dead.  The  same  is  correct  as  regards 
the  later  period  of  pregnancy,  after  the  fifth  month.  There 
are  other  signs  besides,  which  are,  however,  only  to  be 
recognized  by  physicians.  * 

In  the  expelled  foetus  the  presence  of  life  can  be  more 
easily  ascertained  in  the  majority  of  cases.  Three  periods 
should  be  distinguished,  the  first  extending  to  the  end  of 
the  third  month.  Until  then  the  ovum  is  expelled  gener- 
ally whole  and  entire,  and  it  must  be  carefully  cut  open  in 
order  to  see,  etc.,  the  foetus.  Signs  of  life  are  most  generally 
very  difficult  to  ascertain,  because  the  muscles  are  not 
developed  enough  to  make  movements  easily.  Only  the 
palpitation  of  the  heart  can  be  seen,  and,  under  favorable 
circumstances,  very  early.  It  should  be  remembered,  how- 
ever, that  the  heart  (or  the  heart-tube)  lies  immediately 
after  its  formation  altogether  in  the  neighborhood  of  the 
head,  and  makes  its  descent  only  by  degrees.  Pulsation,  or 
a  movement  resembling  pulsation,  when  noticed  in  embryos 
perhaps  only  five  to  six  weeks  old,  must  be  considered  as  a 
certain  sign  of  life.  After  the  close  of  the  third,  that  is, 
lunar  month,  the  development  of  the  muscles  makes  gradual 
progress  ;  but  motions  of  the  trunk  and  the  extremities  will 
seldom  be  noticed  before  the  end  of  the  fifth  month,  when 
the  muscles  will  have  attained  a  comparatively  complete 
development.  At  that  time  motions  of  the  limbs,  of  the 
thorax,  or  of  the  epigastrium  and  of  the  mouth,  can  be 
perceived  more  easily.  Palpitation  of  the  heart  may,  also, 
now  often  be  felt,  other  signs  of  life  being  absent. 

The  Acardiacus  excepted,  every  human  embryo  or 
foetus  must  be  considered  a  human  being,  and  must  be 
baptized  if  living.  If  life  is  doubtful,  it  should  be  baptized 
conditionally  :   '^  Si  vivls,  ^^o,"  etc. 

"  Compare  my  pamphlet,  De  occisione  foetus^  pag.  69. 


150  THE    SACRAMENTS. 

Embryos  of  a  fe^v  months'  existence  must  of  course  be 
baptized,  if  any  sign  of  life  is  noticeable.  *  If,  after  a 
sudden  expulsion,  the  ovum  is  still  fresh,  it  should  be 
baptized  conditionally,  because  there  is  in  this  case  a 
reasonable  doubt  as  to  life's  presence.  Here  the  question 
arises,  whether  a  foetus  that  has  been  expelled  within  the 
closed  ovum  should  be  baptized  after  the  ovum  has  been 
opened,  or  whether  conditional  baptism  on  the  membranes 
enveloping  the  foetus  sliould  take  place  first,  and  be  re- 
peated on  the  foetus  itself  after  the  opening  of  the  ovum  ? 

For  the  reason  above  stated,  "namely,  that  the  outer  coat 
of  the  foetal  membranes  is  not  a  product  of  the  ovum,  and 
does  therefore  not  at  all  belong  to  the  foetus,  I  cannot  ap- 
prove of  tlie  practice  of  administering  baptism  on  the 
closed  ovum.  Debreyne  (1.  c,  page  209)  holds  the  opposite 
opinion,  but  I  think  he  did  not  know  or  did  not  consider 
my  reason  for  differing  from  him  ;  and,  moreover,  I  cannot 
attach  to  his  reason  (namely  :  '^La  crainte,  que  V impression 
de  Tair  ne  fasse  mourir  Is  foetus  avant  cVavoir  regu  le 
hapieme''')  the  same  weight  that  he  does,  t  The  exposure 
to  the  air  will  not  on  the  instant  destroy  life  in  the  foetus, 
if  the  ovum  is  opened  cautiously,  and  if  the  liquor  amnii 
(fruit-water)  is  let  out  slowly.  No  time  should  be  lost  in 
looking  for  signs  of  life.  If  the  ovum  is  fresh,  not  discolored 
or  putrid,  and  if  the  foetus  looks  white,  not  of  a  yellowish 
or  brownish  hue,  baptism  should  be  administered,  immedi- 
ately after  the  opening,  suh  conditione  vitae. 


*  Abortive  ova  form,  very  often,  a  so-called  massn,  carvfa.  In  Piicl)  capes 
tile  ovum  became  degeiieiate  in  consequence  of  efi'iisionsi  of  blt/od,  and  ilie 
foetup  is  ceilainly  dt-ad,  and  offen  already  nhsorbfd.  Here  even  cnndi- 
ti(in;il  b:i|.rifni  cniinot  he  conf.-ii ed.  In  a  dihicei;tted  ovum  (f  the  lii'st 
lew  niontiis  llie  fu'tns  is  always  tltMil. 

t  Debi-eyne  seems  lo  iiave  simply  borrowed  his  view  from  the  Emhnjo- 
loffia  iacra  oi  Caiiyiiamilla.     Compare  this,  lib.  iv,  cap.  vi^  ^  4,  vi. 


OF   BAPTISM.  151 

Debrejne  wants  baptism  to  be  given  to  these  small 
embryos  by  immersion  of  the  whole  opened  ovum.  This 
may  be  very  good,  if  the  embryos  are  yet  very  small^  so 
that  they  merely  float  loosely  in  the  amniotic  liquor,  and 
are  not  reached  with  certainty  by  the  baptismal  water. 
But  I  do  not  see  the  necessity  of  doing  so,  after  they  are 
six  weeks  old.  At  this  time  the  foetus  is  large  enough 
(17-25  millimeters  or  8-12  lines)  to  be  capable  of  baptism 
by  infusion.* 

Also,  if  the  embryos  are  of  somewhat  larger  size, — say, 
after  the  end  of  the  sixth  lunar  month, — no  time  should  be 
lost  in  searching  for  signs  of  life.  If  the  delivery  was 
rather  ^a  hurried  one,  and  if  the  foetus  looks  fresh  (that  is, 
if  no  discoloring  spots  or  discoloring  of  the  whole  skin  is 
found),  baptism  should  be  given  conditionally.  For,  the 
signs  of  life  are  difficult  of  proof  in  such  foetuses,  and  we 
are  therefore  right  in  regarding  them  as  of  doubtful  life, 
if  certain  signs  of  death  are  wanting. 

The  same  applies  in  the  case  of  foetuses  of  later  months 
in  a  state  of  asphyxy  (trance).  Some  few  moments  might 
here  be  taken  up  in  seeking  for  signs  of  life.  But  in  this 
case,  also,  the  foetuses  should  be  baptized  conditionally  as 
soon  as  possible,  if  all  sure  signs  of  death  are  wanting, 
and  if  there  exist  no  other  good  reasons  for  presuming 
death,  such  as  discharge  of  the  amniotic  liquor  some  days 
before  delivery,  or  excessive  floodings  several  hours  before 
delivery  (as  in  case  of  placenta  praevia), 

*  Persons  that  are  not  well  versed  in  this  matter  will,  indeed,  in  practice, 
take  the  sufest  method,  by  conferring  baptism  per  vnmersionem,  thus:  th« 
membranous  envelope  is  ruptui'ed  in  the  water  and  under  the  water  ;  an-d 
immediately  after  the  rupturing  the  words  are  spoken,  Si  vivis,  er/o,  etc. 
The  thumb  and  index  finger  «f  each  hand  take  hold  of  one  of  the  folds  of 
the  envelope,  and  the  latter  is  ruptured  so  that  the  whole  contents  of  the 
ovum  flow  out  and  become  thoroughly  washed  by  the  baptismal  water. 
In  this  manner  the  exposure  of  the  foetus  to  the  air,  which  is  feared  so 
much  bj  sumC;  is  also  ayoided. 


152  THE    SACRAMENTS. 

How  monsters  and  double  formations,  if  living,  must  be 
baptized,  is  sufficiently  clear  from  the  above.  Hemicepha^ 
Ions  foetuses,  should  the  heads  be  ever  so  much  deformed, 
are  certainly  human  beings,  and  must  be  baptized,  if  living, 
unconditionally.  A  foetus  with  one  head  and  one  chest 
(heart)  is  only  one  being,  and  must  be  baptized  once  ww- 
conditionally. — If  there  are  one  head  and  two  chests,  two 
individuals  are  to  be  presumed,  and  baptism  is  to  be  given 
on  the  head  unconditionally,  and  afterward  conditionally 
on  each  single  chest.  (On  eachj  because,  in  this  doubt,  we 
cannot  know  which  chest  was  baptized  with  the  head.) 
If  head  and  chest  are  double  with  one  trunk,  each  head 
must  be  baptized  unconditionally. — If  the  head  Alone  is 
double,  and  the  whole  trunk,  the  chest  (heart)  included,  is 
single,  there  is  only  a,  probahilify  of  two  individuals  j  one 
head  therefore  is  baptized  tmconditionally,  the  other  sub 
conditione.  ^'  Si  vero  pericidum  mortis  immineat,  tempus- 
que  non  suppetaty  ut  singtdi  separathn  bapti^entur,  poterit 
minister^  singuhrwn  capitihus  (aid  pecto^'ibus,  if  there  be 
one  head  and  two  hearts)  aquam  infundens,  omnessimul  bap- 
tisare  dicendo :  Ego  vos  baptisOy^  etc.  (Grury,  i,  pag.  162, 
note  Rituale  Romanum.)* 

*  Of  monsters  and  tlonble  fonnations  I  liave  mentioned  only  those  which 
occur  the  most  frequently,  and  which  are  the  most  remarkable  and  offer 
ihe  principal  ditficuliiea  in  the  matter  of  baptism.  Like  the  cranium,  the 
face,  too.  may  be  wanting;  indeed,  there"  may  be  on)y  a  rudiment  of  a 
head  without  irunk  {Acorinus).  Again,  there  is  son>etiines  only  one  eye 
{Cyclopia),  and  at  times  there  occurs  a  confusion  of  the  lower  extremities 
{Monopodia),  etc.,  etc.  Double  formations  of  lesser  degree  are:  two  faces 
on  one  head,  two  skulls  with  one  head  and  one  face,  etc.  Here  the  Joetus 
infoetu  (Epif/nathus)  may  be  mentioned,  that  is,  an  imperfect  fc&tus  implanted 
diiectly  with  its  blood-vessels  on  a  place  (generally  the  palate)  of  the  per- 
fect foetus,  etc.^  etc.  (Compare  Dr.  H.  von  Fabrice,  Die  Lehit  von  der 
Eindesahtreihnng  und  vom  Kindesmord.     Erlangen,  18l>8. ) 

How  to  act  with  such  maH(<rmations  in  regard  tob«tptism,  may  be  derived 
ex  analof/m  from  the  text.  With  regard  toclitaracterizing  d(Hil»le  foi-mations 
as  two  individuals,  it  may  be  urged  that  they  should,  perhaps,  not  be  re- 
garded as  two  foetuses  grown  tcgeiher,  but  possibly  a.s  the  product  oi'  a  more 


OF   BAPTISM  153 

It  may  seem  to  some  of  my  readers  tKat  I  have  treated 
the  subject  of  baptism  at  too  great,  and  even  unnecessary, 
length.  I  must  excuse  myself  by  the  immeasurable  im- 
portance of  the  sacrament  of  baptism,  and  the  great  danger 
that  really  exists  of  many  a  human  creature — ^^  cujus 
anima,  si  haptismate  non  fraiidaretur,  Deum  in  aeternum 
videret^'  (Roncaglia) — being  deprived  of  it,  through  a 
deficient  knowledge  of  these  matters  on  the  part  of  those 
who  are  present  at  times  of  childbirth. 

Whilst  on  the  subject  of  baptism,  I  must  not  omit  to 
say  a  few  words  on  a  matter  as  to  which  some  of  the 
writers  on  pastoral  medicine  (Macher,  Schreger,  Bluff 
and  others,  even  the  good  Vering )  have  worked  themselves 
into  a  great  state  of  unnecessary  indignation.  With  not 
a  little  sentimentality,  they  have  waged  war  against  the 
ecclesiastical  precept,  that  baptism  should  be  administered 
in  the  church ;  *  those  grievously  sinning  who  act  against 
this  precept  without  necessity.  It  is  clear  that  children  in 
a  trance,  or  those  whose  death  may  be  reasonably  feared 
to  soon  occur,  can  be  baptized  at  home  ex  necessitate, 
either  immediately  or  at  least  soon,  ne  periculum  subeat 
sine  haptismo  moriendi.  Scavini  says  (1.  c,  tom.  iii,  pag. 
485,  note  5):  ^'' Haec  autem  sunt  hujusce  periculi  signa 
praecijMa ;  1.  Si  puer  oriatiir  sine  vagitii  et  lacrimis.  2, 
Si  modice  respiret.  3.  Si  appareat  lividas  praesertim  in 
facie  aut  capite.  4.  Si  nascatur  post  mtdtum  labor  is  ohste- 
tricis.  5.  Si  enascatur  ante  septimum  mensem.  6.  Si  cranium 
haheat   valde   moUe,  aut  siituras  nimis  apertas,  aut  alias 

or  less  complete  splitting  of  one  generative  germ.  The  history  of  develop- 
ment does  not  throw  any  light  upon  this  subject.  I  think  we  have  to  deal 
with  what  we  see  before  us,  and  must  act  according  to  probable  reasons,  in 
case  of  doubt;  so  that  no  human  being  may  run  the  risk  of  dying  without 
baptism. 

*  And  not  in  the  sacristy,  unless  there  is  good  reason,  on  the  strength  of 
which  permission  is  granted  by  the  ecclesiastical  authoiity. 


154  THE    SACRAMENTS. 

paries  disjundasy  Scavini  certainly  intends  to  include 
within  the  last  category  all  malformations  of  the  important 
organs  of  life,  because  all  such  malformations  involve  the 
danger  of  an  early  death.  ^^  Sine  necessitate "  means,  • 
therefore,  that  the  child  should  be  brought  to  church, 
unless  there  is  a  reasonable  fear  of  serious  danger  arising 
therefrom  to  the  child.  Also,  any  acute  disease  would  be 
a  reasonable  cause  for  baptizing  the  child  in  the  house,  if 
an  early  recovery  cannot  be  expected.  Many  synods  have 
prescribed  that  baptism  should  not  be  postponed,  without 
special  permission  of  the  ecclesiastical  authorities,  beyond 
the  tliird  day.  Scavini  adds  (1.  c,  pag.  484)  that  it  is 
communius  et  x>rohabilius  that  a  delay  not  going  beyond 
the  tenth  or  eleventh  day  is  not  of  a  grave  character.  Thus 
there  is  ample  room  to  select  favorable  weather,  if  the 
child  be  otherwise  healthy.  Objections  made  on  account 
of  mad  drives  through  snow  and  rain  ;  dissolute  eating  and 
drinking  feasts  at  the  parish-place,  and  careless  treatment 
of  the  poor  child  when  returning  (in  country  ilistricts), 
are  not  well  taken,  as  these  are  things  that  can  be  avoided. 
Likewise  the  child  can  be  guarded  against  suffering  from 
cold  air,  or  from  too  cold  baptismal  Avater,  if  only  proper 
care  is  taken.  If  the  holy  act  is  performed  soon  after  the 
arrival  of  the  child  in  church,  without  a  long  delay  caused 
by  waiting  for  the  minister ;  if  the  baptismal  water  is 
waru'ed  a  little  ;  if,  in  case  of  very  severe  cold,  baptism  is 
administered  \n  the  sacristy, — in  short,  if  all  obnoxious 
agencies  are  as  much  as  possible  set  aside,  there  will  arise, 
only  in  very  rare  cases,  a  serious  injury  to  the  child  from 
baptism  being  administered  In  the  church.  Baptism  in  the 
house  is  a  Protestant  invention  ;  and  it  is  probably  on  this 
account  tliat  it  is  defended  with  such  show  of  indignation 
and  sentimentality. 


OF   COMMUXION.  155 

II._COMMUNION. 

The  subject,  and  the  bodily  disposition,  are  all  with 
which  we  have  to  do  in  this  treatise. 

The  Church  has  declared  that  every  Christian  is  bound 
to  communicate  on  two  occasions,  viz.,  at  Easter,  and  in 
danger  of  death. 

This  commandment  is,  however,  dispensed  with,  in  the 
case  of  children  not  yet  ^^.rrived  at  years  of  discretion,  of 
those  who  since  birth,  or  since  any  time  before  the  age  of 
reason,  have  been  amentes,  idiotic,  or  mentally  disturbed, 
and  of  those  who  are  deaf  and  dumb  and  blind  at  the  same 
time,  ^^  cum  in  illis  nulla  dlscretlo  inveniri  possiV- 

Communion  can,  and  must,  be  administered  to  lunatics, 
idiots,  and  mentally  diseased  persons  in  articulo  mortis^ 
if  they  were  not  always  mentally  disordered,  and  had  at 
any  time  previously  enjoyed  the  use  of  reason,  ^^  nisi  forte 
timeaiur  periculum  vomitus  vol  expuitionisy  But  with 
regard  to  such  persons,  I  should  think  it  always  necessary 
to  take  into  consideration  their  former  life  :  for  instance, 
is  there  an  obligation  to  administer  the  viaticum  in  articulo 
mortis  to  a  man  who  has  destroyed  his  reason  by  habitual 
drunkenness  continued  through  years,  and  who  arrives  at 
the  point  of  death  without  a  lucid  interval  ?  St.  Thomas 
says:  ''^ Si  prius^  qiiando  erant  compotes  suae  mentis^  ap- 
paruit  in  cis  devotio  Jiujus  sacramentiJ^  The  previous  life  of 
many  a  mentally  diseased  person  had  been,  it  may  be,  before 
his  reason  gave  way,  but  a  connected  chain  of  mortal  sins, 
which  led  him  to  the  very  threshold  of  mental  disturbance. 
Can  it  be  presumed  that  such  a  one  had  a  desire  of 
receiving  holy  communion  before  he  lost  his  reason  ? 

Persons  who  are  in  the  delirium  of  fever,  or  in  an  un- 
consciousness   probably  ending    in  death,  belong    to    the 


156  THE    SACRAMENTS. 

same  category  as  to  holy  communion.  If  they  are  able  to 
swallow,  which  must  be  tried  beforehand,  they  may  receive 
under  the  same  conditions  as  the  insane.  It  will  be  of  use 
to  let  such  persons  drink  a  little  water  or  wine  immediately 
after  the  taking  of  the  species,  because  they  often  swallow 
fluids  easily  enough,  but  retain  the  dry  species  in  their 
mouth,  as  the  latter  does  not  excite  them  to  swallowing. 
The  fluid  excites  the  throat  to  the  act  of  swallowing.  It 
does  not  matter  if  a  part  of  the  water  should  reach  the 
stomach  sooner  than  the  species,  because  jejunium  is  not 
required  in  danger  of  death,  which  then  exists.  (Compare 
further  down.) 

Imbeciles  (semifatui)  can  receive,  if  they  are  able  to 
discern  the  body  of  the  Lm'd.  I  do  not  understand  why 
some  of  the  moralists  (cf.  Gury,  tom.  ii,  218)  make  the 
restriction  that  communion  should  be  administered  to  such 
semifatui  only  m  articulo  mortis  et  ubi  urget  strictum  commu- 
nicandi  praeceptum.  If  a  man  is  capable  of  discerning,  there 
is  certainly  no  irreverence  in  more  frequent  communion ; 
if  not,  the  same  applies  as  in  the  case  of  totally  deranged 
persons. 

Communion  can  be  administered  to  the  insane  who  have 
lucid  intervals,  during  these  lucid  intervals,  if  they  show 
a  desire  for  it.  But  in  this  case,  it  is  best  to  be  properly 
informed  by  the  persons  around  the  patient,  but  especially 
by  the  physician,  about  the  nature  of  those  lucid  intervals, 
and  their  duration  as  known  from  experience. 

Deaf  and  dumb  people  that  have  sufficient  discretion  can, 
of  course,  receive  oftener  ;  also,  blind  persons.  Epileptics 
cannot  communicate  during  fits.  During  the  intervals, 
there  can  only  be  the  hindrance  that  the  seizures  occur  so 
frequently  that  there  is  scarcely  ever  sufficient  hope  of 
safety  from  them.  In  such  cases^  the  psychical  derangement 


OF   COMMUNION.  157 

makes  siicli  rapid  progress  that  these  patients  must  be 
treated  like  idiots  or  imbeciles.  If  the  patient  knows 
from  experience  that  he  is  attacked  by  a  fit  very 
often,  or  almost  always,  whilst  in  church,  then  I  think  he 
is  entitled  to  receive  his  Easter  communion  in  the  house, 
in  the  same  way  as  other  sick  persons. 

Regarding  the  bodily  disposition,  the  moralists  say  that 
natural  diseases,  even  those  of  a  disfiguring  or  nauseating 
character,  have  no  influence  on  the  disposition,  because  in 
themselves  they  neither  hinder  the  devotion  nor  ^^ pertinent 
ad  moralem  honitatemy  Of  pollution  and  the  marital  act, 
which  are  referred  to  by  some  (for  instance,  by  Scavini  in 
the  chapter,  Dispositiones  ex  parte  corporis),  we  take  no 
notice  here,  because  they  affect  more  the  disposition  of  the 
soul  than  of  the  body.  If  there  be  absolutely  nothing  sinful 
in  them,  they  have  no  influence  on  the  disposition.  But 
it  is  certainly  very  desirable  that  the  marital  act  be  avoided 
at  least  shortly  before  holy  communion,  because,  although 
licit,  it  always  is  accompanied  by  a  certain  perturbation. 

The  principal  points  regarding  the  bodily  disposition 
are  :  proneness  to  vomiting,  and  jejuniiim  naturale. 

Holy  communion  should  not  be  administered,  according 
to  the  moralists,  to  those  sick  persons  who  are  afflicted 
with  vomiting,  at  least  not  before  some  six  hours  have 
elapsed  since  the  last  spell  of  vomiting.  Coughing,  how- 
ever frequent,  and  with  much  expectoration,  is  no  hin- 
drance to  communion,  because  the  sputa  expelled  by  the 
cough  do  not  come  from  the  stomach  and  esophagus, 
but  from  the  lungs  and  windpipe  ;  only,  in  momentarily 
violent  coughing-fits,  the  host  might  be  expelled  by  the 
force  of  the  cough,  or  through  vomiting  caused  by  reflex 
nervous  action.  In  this  case,  either  communion  must 
not  be  given,  or  at  least  the  subsiding  of  the  fit  must  be 


158  THE    SACRAMENTS. 

waited  for.  By  real  vomiting  the  species  is  expelled 
from  the  stomach.  Therefore,  if  there  is  a  presumption 
of  vomiting  soon  after  communion,  or  if  tliere  is  a  doubt 
whether  vomiting  might  ensue,  communion  cannot  be 
given.  If  not  certainty,  at  least  probability  that  vomiting 
will  not  take  place  shortly  after  communion,  is  required. 
Here  the  question  arises :  Does  it  suffice  to  constitute  this 
probability,  or  is  it  necessary  for  it,  that  at  least  six  hours 
have  elapsed  since  the  last  spell  of  vomiting  1  If  vomiting 
before  took  place  oftener,  and  at  short  intervals^  then  there 
is  the  presumption  that  now  a  longer  interval,  even  one 
less  than  six  hours,  gives  hope  hi  duhio  that  the  little 
irritation  caused  by  the  species  will  not  excite  the  some- 
what calmed  stomach  to  a  new  vomiting-fit.  But  if 
vomiting  took  place  before,  at  irregular  intervals  of  longer 
or  shorter  duration,  and  if  no  change  was  efi'ected  in  the 
general  state  of  health,  I  think  even  an  interval  of  six 
hours  may  not  offer  a  sufficient  security.  In  cholera,  for 
instance,  vomiting  takes  place  very  frequently  ;  and  an  in- 
terval of  two  to  four  hours,  but  certainly  one  of  six  hours, 
shows  a  change  which  gives  hope  for  an  intermission  of 
vomiting ;  but  in  diseases  and  lesions  of  the  brain,  in 
diseases  of  the  kidneys,  in  inflammation  of  the  bowels, 
vomiting  ensues  at  shorter  and  more  regular  intervals. 
During  those  affections,  I  should  require  a  non-recurrence 
of  vomiting  for,  at  least,  twelve  hours,  bef)re  I  would 
allow  communion  to  be  given.  The  same  applies  to  vomit- 
ing in  cases  of  strangulated  hernia,  and  to  the  so-called 
irrepressible  vomiting  of  pregnant  women.  In  each  single 
case,  the  best  way  is  to  consult  the  physician,  whether  he. 
thinks  that  communion  may  be  given  vvithout  danger  of 
vomiting.  Besides,  1  would  counsel  not  to  give  communion 
to  the  patient,  even  in  case  of  a  sufficient  interval  elapsing 


OF    COMMUNION.  159 

between  the  vomitinf^-fits,  before  he  has  partaken  of  a 
small  quantity  of  solid  or  liquid  food,  be  it  only  water,  after 
tlie  last  lit.  For,  if  the  patient  has  taken  no  food  at  all 
since  the  last  fit,  it  may  be  expected,  or  at  least  feared, 
that  even  the  slight  irritation  of  the  species  may  produce 
a  new  one.  But,  if  he  can  bear  this,  the  species  will 
probably  not  excite  vomitini^.  The  same  applies  to 
affections  where  the  vomiting  does  not  come  directly  from 
the  stomach,  but  originates  from  the  brain,  or  ensues 
through  sympathetic  action,  for  instance,  from  the  kidneys 
or  from  the  peritoneum  ;  for  here,  too,  by  the  irritation  of 
the  mucous  membrane  of  the  stomach,  vomiting  may  be 
produced  through  reflex  action. 

After  communion,  the  patient  should  keep  very  quiet, 
and  should  not  take  any  drink  ;  or,  if  this  is  necessary  in 
order  to  swallow  the  species,  only  a  very  small  quantity. 
The  best  drink  is  cool  fresh  water;  if  it  can  be  had,  ice- 
water.  Ice  is  a  very  good  means  to  lessen  the  inclination 
to  vomiting,  and  at  the  same  time  it  is  so  harmless  that 
the  pliysician  need  not  be  consulted.  Swallowing  bits  of 
ice  affords  the  best  relief  in  such  cases. 

The  so-called  vomitus  'm%tiitlniis  needs  special  mention, 
because  other  conditions  are  present.  ,  It  occurs  generally 
in  persons  who  have  been  addicted  to  the  abuse  of  alco- 
holic drinks  for  a  long  time.  Chronic  gastritis,  or  clironic 
bronchitis,  or  only  one  of  these  affections,  is  its  cause. 
Thus  it  may  occur  also,  independently  of  the  abuse  of 
alcoholic  drinks,  if  these  affections  arise  from  other  causes. 
But  hard  drinkers  are  chiefly  attacked.  In  the  morning 
after  rising,  either  before  anything  has  been  eaten,  or  as 
soon  as  something  reaches  the  stomach,  a  very  distressing 
retching  sets  in.  Without  real  sense  of  nausea,  but  under 
violent  exertions  (because  the  stomach  is  quite,  or  nearly, 


100  THE    SACRAMENTS. 

empty),  a  certain  quantity  of  mucus  is  expelled,  together 
with  residues  of  food.  Persons  afflicted  with  vomitus 
matutinus  are  certainly  very  much  in  danger  of  expelling 
the  species.  They  are  not  allowed  to  take  ice  or  any 
other  anti-emetic  before  communion,  as  the  obligation 
of  fasting  cannot  be  suspended  in  their  favor.  The  best 
thing  for  them  is  to  rise  early  on  communion-days,  and  to 
go  to  the  church  only  after  the  vomiting  has  subsided. 
If  the  disorder  has  had  its  origin  in  drinking,  total 
abstinence  must  be  practised,  and  medical  counsel  sought 
for  their  gastritis  or  bronchitis. 

Of  frequent  occurrence  is  another  vomitus  matutinus, 
namely,  that  during  the  first  months  of  pregnancy.  It 
also  takes  place  either  before  anything  has  been  eaten,  or 
after  the  first  food  has  been  partaken  of.  It  is  chiefly  of 
occurrence  during  the  first  months  of  pregnancy,  and  often 
ceases  after  the  third  or  fourth  month.  Women  thus 
afflicted  have  to  refrain  from  going  to  communion,  until 
they  know  by  the  experience  of  some  days  that  a  recur- 
rence of  the  vomiting  is  not  to  be  feared. 

But  if,  nevertheless,  vomiting  takes  place  after  com- 
munion, what  is  to  be  done  regarding  the  expelled  matter  ? 
At  what  time  after  receiving  can  we  regard  the  corruption 
of  the  species  as  completed  ?  The  digestive  process  is  not 
always  completed  in  the  same  period,  because  it  is  depend- 
ent on  the  greater  or  lesser  quantity  of  fluid  contained  in 
the  stomach,  on  the  more  or  less  active  secretion  of  the 
gastric  juice,  on  the  peristaltic  movements  of  the  stomach, 
etc.;  yet  it  is  to  be  presumed  that  the  species  is  completely 
digested,  and  can  be  regarded  as  not  any  more  existing,  in 
half-an-hour  after  communion.  A  mechanical  dissolution 
and  division  takes  place  sooner,  but  this  is  not  the  same  in 
my  opinion  as  corruption  of  the  species  pan  is -.  corruption,  I 


OF    COMMUNION.  161 

tliinkj  is  accomplished  only  when,  through  the  action  of  the 
gastric  juice,  the  nature  of  the  species  is  changed  in  the 
process  of  chemical  solution,  so  that  it  is  not  any  longer 
bread.  *     Cardinal  de  Lugo  t  is  of  the  opinion  that  the 
small   morsel  of  species  given  to  lay  people  becomes  cor- 
rupted in  one  minute,  and  the  large  host  and  the  species 
vini  in  a  quarter  of  an  hour.     Collet  j:  says  that  vomiting 
must  be  guarded  against  for  lay-people  during  a  quarter — 
for  the  celebrating  priest,  during  halt — an  hour.     I  believe 
that  half-an-hour  is  the  minimum  I  can  allow  of,  before  a 
real  and  complete  corruption  of  the  species  takes  place. 
The  difference  between  the  smaller  and  larger  size  of  species 
I  deem  of  no  great  importance  ;  for  even  the  larger  host  is 
comparatively  small,  and  can  be  easily  affected  and  chemi- 
cally altered  by  the  gastric  juice  in  the  same  time  as  the 
smaller  one.     I  believe  that  half-an-hour  is  likewise  amply 
sufficient  to  effect  a  corruption  of  the  species  vini.     If  vomit- 
ing occurs  before  half-an-hour  has  elapsed  after  receiving, 
the  expelled  matter  must  be  treated  in  the  same  manner  as 
the  Church  prescribes  in  the  case  of  vomiting  oiincorrupted 
species,  if  visible  particles  be  not  existing,  or  not  found. 
As  is  well  known,  visible  and  recognized  particles  of  the 
species  must  be  taken  and  preserved  in  loco  sacrOj  tuto  et 
bene  clauso,  and  left  to  be  corrupted,  before  it  is  allowed  to 
cast  them  into  the  sacrarium. 

And  now  it  remains  to  speak  of  the  jejunium  naturale 
before  communion,  that  is  :  ahstinentia  totalis  post  mediam 
noctem  a  re  qiialibet,  quantumvis  minima^  quae  sumitur  per 
modum  cihi  et  potus. 

*  TliJit  meat  s.  of  course,  so  that  the  species  has  lost  the  physical  and 
chemical  qualities  of  bread,  of  the  accidents  ot  bread.  To  the  accidents  of 
brend  he]on<r  certaiidy  also  the  chemical  qualities, 

t  Disput.  10,  cie  ICuchar.,  n.  54. 

XTraitedes  ss.  Afyst.,  ch.  xiv,  n.  14.  (Quoted  after  P.  J.  B.  de  Herdt,  Sacrae 
Liturgiae  praxis.  Lovauii,  1863,  lom.  ii,  pag.  224.) 


162  THE    SACRAMENTS. 

There  is  scarcely  any  precept  which  is  treated  by  the 
moralists  with  more  scrupulosity  and  precision  than  this 
command  of  fasting  from  midnight  before  holy  communion. 
They  say : — 

Farticles  of  food  that  remain  between  the  teeth  do  not 
break  the  fastjif  swallowed  involuntarily,  '^  quia  non  habent 
rationem  cibiP  Some  hold  that  a  voluntary  swallowing 
is  not  allowed,  and  require  that  such  particles  at  least  as 
are  felt  on  the  tongue  be  spit  out.  Others  again  do  not 
find  in  this  a  breaking  of  the  fast  ]  because,  if  it  were, 
it  might  be  the  occasion  of  innumerable  scruples  and 
anxieties. 

A  drop  or  so  of  wafer,  or  of  other  fluids,  swallowed  un- 
intentionally, as  for  instance,  when  Avashing  the  teeth,  does 
not  break  the  fast,  ''rnodo  non  sint  in  magna  quantitate.'^ 
If  swallowed  intentionally,  the  fast  is  broken,  ^^  quia  tunc 
nihil  deest,  tit  rationem  cibi  aut  potus  JiaheantJ^ 

Snuff  does  not  break  the  fast,  even  though  some  dust 
may  reach  the  stomach,  ^^  quia  non  sum  it ur  per  modum 
comestionis.^^ 

Tohacco-smoJce,  camplior-vapor,  vapors  from  cooJced  foods 
in  the  kitchen,  do  not  break  the  fast,  according  to  the 
accepted  opinion. 

Chewing  tobacco  is  in  the  highest  degree  unbecominir 
before  communion,  and  therefore  it  is  forbidden  suh  venicdi. 
if  done  without  grave  reason  ;  but  it  does  not  break  the  fast. 
even  if  a  little  of  the  tobacco-juice  mixed  with  the  saliva 
is  swallowed  unintentionally^  for  the  juice  is  then  swallowed 
per  modum  salivae.  Men  do  not  intentionally  swallow  tn> 
bacco-juice.  Should  this  occur,  however,  the  fast  is  certainly 
broken. 

In  regard  to  this  fast,  the  moralists  do  not  allow  any 
infringement  as  being  trivial,  whether  there  be  questioa 


OF   COMMUNION.  163 

of  tlie  time  at  whicli  the  food  is  taken,  or  of  the  quantity 
of  it.  As  soon  as  that  clock  from  which  we  are  ordinarily 
in  the  habit  of  taking  our  time,  whether  from  choice  or 
necessity  (it  is  here  ahowed  to  follow  the  slower  of  two 
varying  clocks,  unless  the  variation  should  be  extravagant), 
strikes  the  first  stroke  of  twelve  P.  M.,  the  obligation  of 
fasting  begins:  ^^  Qui  aliquid  sumit  post  primiim  ictum, 
{licet  ante  ultimum)  non  ampUus  potest  commimlcare.^^ 
(Scavini,  1.  c.,  torn,  iii,  pag.  5G5.) 

Tliese  detailed  observations  tend  to  show  how  much 
importance  is  attached  to  this  precept.  The  same  can  bo 
inferred  from  tlie  strictness  of  the  moralists  in  stating 
exceptions.  In  consideration  of  this  unanimous  agree- 
ment of  the  moralists  as  to  the  importance  of  fasting, 
and  because  of  the  stress  laid  by  all  of  them  upon  the 
necessity  of  strict  and  precise  observation  of  the  precept, 
I  will  not  extend  my  observations  upon  the  subject. 

Waiving  all  scruples  that  may  be  suggested,  looking  at 
the  matter  from  a  medical  standpoint,  and  any  wishes  I  may 
entertain  in  that  connection,  I  restrict  myself  to  merely 
enumerating  those  exceptions  to  this  rule  which  I  find 
enumerated  by  the  moralists  as  being  alone  admissible. 
These  are  :  Periciclum  profanationis  ;  periculum  scandaU 
vcl  gravis  infamiae  (on  the  part  of  the  priest);  nccessitas 
pcrficicndi  sacrificium ;  finally,  one  which  particularly 
interests  us  here  :  pericidiim  moriis,  ex  quaeimqiie  causa 
proveiiiat.  Persons,  therefore,  in  danger  of  death  are 
permitted  to  receive  the  blessed  sacrament  by  way  of 
viaticum,  although  they  may  not  be  fasting.  It  is  not 
necessary  that  death  be  directly  imminent,  or  be  sure  to 
fdllow  from  the  existing  disease.  Communion  may  be 
given  to  patients  not  fasting,  if  the  disease  be  of  a  fatal 
nature  and  directly  endangering  life.     Such  patients  may 


164  THE    SACRAMENTS. 

receive  repeatedly,  though  not  fasting  5  as  long,  namely, 
as  the  danger  lasts,  or  if  the  danger,  which  seemed  to 
have  disappeared,  should  return  or  increase.  This  applies 
especially  to  all  sudden  emergencies  endangering  life,  as 
well  as  to  acute  diseases  from  which  death  may  be  appre- 
hended. In  chronic  diseases,  th^  rule  of  fasting  cannot 
be  neglected  before  the  disease  has  entered  the  stage 
wherein  death  commonly  ensues,  or  unless  special  danger 
arises  from  particular  complications.  Neither  is  there,  in 
these  contingencies,  an  absolute,  or,  so-called,  moral, 
certainty  of  immediate  danger  to  life  required  :  it  suffices 
that  there  is  a  reasonable  doubt,  or  a  probability  of  such 
danger.  Of  course,  the  patients  must  observe  the  rule 
of  fasting,  if  they  are  able  to  do  so  without  notable  injury 
or  prejudice  to  their  state  of  health,  which  in  chronic  dis- 
eases is  generally  possible,  even  in  the  last  stage.  But  in 
this  matter  no  place  must  be  given  to  over-scrupulousness. 
Patients,  who,  although  bed-ridden,  are  not  suffering  from 
a  disease  dangerous  to  life,  cannot  receive,  even  at  Easter- 
time,  according  to  the  common  opinion,  if  they  are  not 
fasting.  The  same  applies  to  those  who  are  not  exactly 
sick,  and  yet  cannot  fast.  Some  moralists,  indeed,  allow 
such  people  to  receive  a  few  times  during  the  year,  al- 
though they  may  not  be  fasting.  But  these  constitute 
a  very  small  minority.  The  general  opinion  of  theologians 
is  against  them.  Only  the  pope  can  grant  dispensation  in 
such  cases,  which  he  does  very  seldom,  and  only  for  very 
grave  reasons.  ^'  Videtur  vero,^^  says  Gury  (tom.  ii,  page 
227),  ^'  tunc  adesse  ratio  sufficlens  cur  interdiim  Eucharlstla 
post  mediam  noctem  infirmo  administrari  possit^ 

We  ought,  perhaps,  here  say  something  about  the 
circumstances  which  make  it  impossible  for  a  patient  to 
keep   the  fast.     These  cases  are  mostly  those   in   which 


OP  EXTREME    UNCTION.  165 

only  medicines  and  drinks  come  into  question.  As  to  the 
former,  the  prescription  of  the  physician  must  be  attended 
to.  As  to  drinks,  there  is  no  doubt  that  very  many 
seriously  sick  persons  cannot  abstain  from  drinking  for  a 
few  hours,  without  serious  annoyance.  They  need  not 
undergo  this  annoyance  when  in  danger  of  death.  It 
depends  therefore  on  the  patient  himself  whether  or  not 
he  can  abstain  without  inconvenience.  To  point  out  the 
diseases  and  affections  wherein  drink  must  be  frequently 
given,  would  be  out  of  place  here  ;  and  to  do  so  might  only 
lead  to  confusion  and  anxiety.  If  the  fasting  be  not  pro- 
tracted too  long,  that  is,  if  communion  be  administered  as 
early  as  possible,  the  patient  himself,  in  most  cases,  will 
insist  upon  keeping  the  fast,  provided  it  is  not  otherwise 
ordered  by  the  physician. 

III.— EXTKEME  UNCTION. 

Extreme  unction  is  a  sacrament  in  which  the  Christian 
who  is  grievously  ill  receives  graces  for  his  soul,  and 
through  which,  also,  he  may  recover  bodily  health,  if  the 
recovery  be  necessary  or  conducive  to  his  spiritual  wel- 
fare. Although  this  sacrament,  like  all  others,  is  directly 
administered  for  the  health  of  the  soul,  it  is  de  fide  that 
it  may  also  restore  the  health  of  the  body,  if  it  be  expedient 
for  the  good  of  the  soul.  Hence  it  follows  that  it  is  wrong 
to  postpone  this  sacrament  until  death  is  already  begin- 
ning to  take  possession  of  the  patient. 

To  justify  the  administration  of  this  sacrament,  it  suffices 
that  the  sickness  be  grievous.  The  same  person  cannot 
receive  extreme  unction  more  than  once  in  the  same  illness, 
unless,  the  dangerous  crisis  having  passed  away,  the  sick 
person  should  again  fall  into  the  same  critical  condition. 


166  THE   SACRAMENTS. 

To  children  under  the  age  of  reason,  or  to  those  who 
have  never  had  the  use  of  reason  since  their  birth  (con- 
genital idiocy),  the  sacrament  of  extreme  unction  cannot 
be  administered.  But  it  can  be  given  to  other  insane  folk 
and  to  idiots,  to  delirious  and  unconscious  persons,  to  the 
deaf  and  dumb,  and  even  to  those  who  have  been  both 
deaf  and  dumb  from  their  birth. 

^^lluUeri  vero  laboranti  in  partu,  si  lahoret  doloribus 
communibus  et  ordinariis,  non  debet  dari  Vnctio  Kxtremaj 
cfiamsi  prima  vice  pariat  aid  alias  fucrit  in  vitae  pericido; 
tunc  etiam  non  laborat  infirmitnte  pericidosa.  Sic  in  Con- 
cilio  Mediolanensi  II  prcescriptum  est;  neque  enini  ilia 
dolorum  acerbitas  est  infirmitas,  sed  effectiis  naturalis 
partus.  (Benedictus  XIV,  De  Syn.  Dioec.  1,  viii,  c.  vi.) 
Secus  esset,  si  lahoret  doloribus  extraordinariis;  tunc  debet 
inungi,  cum  jam  infirmitas  pericidosa  sit,  et  adsit  mortis 
periculumy  (Scavini,  1.  c,  torn,  iv.,  pag.  207.) 

To  women  in  childbirth  extreme  unction  can  be  given 
only  if  there  is  danger  of  approaching  death,  if  they  are 
in  articido  mortis  for  instance,  if  a  condition  dangerous 
to  life  supervenes  from  a  violent  flooding,  through  an  in- 
ward laceration,  or  through  eclamptic  cramps,  etc. 

Before  an  operation  dangerous  to  life,  extreme  unction 
can  be^  administered  only  in  cases  wherein  the  morbid 
affection  that  necessitates  the  operation  is  in  itself  danger- 
ous to  life  ;  for  instance,  when  the  Csesarean  operation  is 
performed  because  delivery  is  impossible  in  any  other  way. 
But  it  cannot  be  given  before  performing  any  dangerous 
operation,  if  the  disease  itself  does  not  directly  threaten 
life :  take,  for  instance,  the  case  of  a  malignant  ulcer  from 
which  there  is  no  immediate  danger  to  life.  Here,  a 
hazardous  operation  having  become  unavoidable,  the 
danger  to  life  is  not  directly  arising  from  the  disease  itself, 


OP   EXTREME    UNCTION.  167 

but  is  brought  about  proximately  by  tlie  operation. 
Extreme  unction,  therefore,  cannot  be  administered  in 
this  case. 

Regarding  the  act  of  anointing,  the  moralists  allow  it  to 
be  performed  in  contagious  diseases,  not  directly  with  the 
finger,  but  medianfe  penicillo.  Of  course,  I  do  not  deny 
that  such  a  proceeding  is  allowable,  but  I  strongly  advise 
its  not  being  adopted  5  first,  because  the  precaution  is  not 
necessary,  as  the  danger  of  infection  is  always  very  slight. 
Even  in  such  diseases  as  are  communicated  by  contact, 
the  oil  itself  protects  from  the  transmission  of  the  virus.  * 
Moreover,  those  parts  of  the  body  may  be  selected  for 
anointing  which  are  the  least  visited  with  the  ulcers,  poxes, 
etc.  In  the  majority  of  diseases  of  this  class,  no  actual 
contact  is  required  for  their  communication,  but  the  con- 
tagious matter  appears  transmissible  by  the  air.  Avoid- 
ance of  contact,  therefore,  is  useless. 

Another  reason  which  inclines  me  to  discourage  such  a 
method  of  anointing,  is  the  scandal  given  thereby.  The 
persons  around  the  patient  wonder  and  are  scandalized,  if 
they  see  the  priest  anxious  and  fainthearted,  when  they 
observe  the  physician  repeatedly  touching  and  handling 
the  sick  person  without  any  such  timidity.  What  would 
become  of  the  sick,  if  physicians  were  possessed  of  a 
similar  fear  of  contagion  ?  And  what  would  become  of 
physicians  themselves,  if  the  danger  of  infection  were 
really  so  great  as  to  render  desiriible  such  a  precaution  on 
the  part  of  the  priest  ?  Such  is  the  question  people  will 
certainly  ask  themselves,  and  will  judge  accordingly. 

*  The  holy  oil  may  possibly  become  infected  through  the  repeated  dipping 
of  the  finger.  In  order  to  avoid  this,  a  piece  of  cotton  may  be  dipped  into 
the  holy  oil,  in  such  a  manner  that  all  the  unctions  may  be  performed  with 
it  as  instrument  Avithout  another  dipping.  The  smallest  apprehension  of 
becoming  infected  is  hereby  avoided. 


168  THE   SACRAMENTS. 

Here  is  the  place  in  which  to  speak  of  the  duty  which 
is  incumbent  on  the  physician  of  taking  care  that  a  patient 
who  is  in  danger  of  death  provides  in  time  for  the  welfare 
of  his  soul. 

^'  Gravissime  peccat  medicus,  si  non  praemoneat  de 
gravi  periculo  aegri,  ut  ipsi  sacrarnenta  conferantur.^''  (Gury, 
Tract,  de  ohlig.  medicoruin,  III,  ii.)  ^^  Caveat  aiitem  medicus, 
ne  diutius  monitionem  differri patiatur.  Non  enim  protraliere 
debet  usque  dum  certum  sit  mortis  periculum ;  sed  ad  hoc 
officium  tenetur,  quando  advertit periculum  graviter  imminere. 
Si  hunc  morem  servarent  medici,  non  adeo  aegroti  admoni- 
tionem  reformidarent  nee  ad  confessionis  mentionem  terrors 
corriperenturJ^  (  Id.,  Quaest.  1.) 

This  obligation  is  clear,  and  recommends  itself  to  com- 
mon sense.  There  is  really  little  to  be  added.  Unhappily, 
at  least  in  our  country,  the  bad  custom  prevails  of  sending 
for  the  priest  only,  quando  certum  sit  mortis  periculum. 
Hence  comes  the  terror  of  the  patient  and  of  the  persons 
surrounding  him,  when  the  physician  speaks  of  the  priest  j 
hence  the  reserve  of  physicians  in  recommending  the  calling 
in  of  the  priest.  Nobody  can  effect  a  change  in  this  re- 
gard but  the  physicians  alone.  Would  that  all  of  them 
would  but  avowedly  recognize  this  fact !  The  Lateran 
Council  (1215)  commanded  expressly  that  no  physician 
should  undertake  the  treatment  of  a  case,  even  although 
not  of  a  dangerous  character,  before  the  patient  had  con- 
fessed, or  had  been  reminded  by  him  of  confession.  But 
i\iQ  sententia  communis  msAutiiin?,  (Scavini,  i,  pag.  452)  that 
this  is  necessary  only  in  diseases  really  dangerous  to  life, 
or  in  such  as  may  become  so  afterward.  It  is  consequently 
prescribed  to  remind  a  patient  of  receiving  the  holy  sacra- 
ments at  the  beginning  of  a  disease  which,  there  is  good 
reason    for   prognosticating,    may,    during    its    progress^ 


OP   EXTREME    UNCTION.  169 

become  dangerous  to  life.  This  precept  binds  sub  gravi. 
However,  Pope  Benedict  XIV  says  (Scavini,  ibid.)  that 
the  physician  is  not  bound,  according  to  the  common 
opinion  of  theologians,  to  leave  the  patient,  if  he  is  not 
willing  to  confess,  and  if  the  physician  cannot  leave  him 
without  danger. 

To  physicians  who  feel  themselves  to  be  strictly  bound 
by  the  Church's  precept  to  remind  patients,  in  time,  of  the 
duty  of  confessing,  it  is  certainly  most  painful  to  see  their 
desire  to  have  the  priest  called  in  often  regarded  as  the 
death-sentence.  They  should  therefore  exert  themselves 
for  the  restoration,  little  by  little,  of  a  more  reasonable  and 
Christian  way  of  looking  at  things.  It  would  soon  have  the 
effect  of  eradicating  all  dread  of  receiving  the  last  sacra- 
ments, were  physicians  never  to  neglect  their  duty  of 
having  the  priest  called  in  at  an  early  stage  of  every  disease 
dangerous  to  life.  This,  of  course,  would  also  be  necessary 
before  serious  operations,  even  if  there  were  no  clear  dan- 
ger of  death  during  their  performance.  For,  after  a  serious 
operation,  especially  if  the  wound  should  take  a  bad  turn, 
the  patient  is  often  not  able  to  receive  the  sacraments  with 
full  consciousness ;  and  there  is  thus  a  possibility  of  his 
dying  without  them.  Moreover,  the  quieting  effect  which 
experience  shows  to  result  invariably  from  receiving  the 
sacraments,  will  make  the  patient  look  on  the  operation 
with  more  confidence  and  with  more  moral  strength.  The 
success  of  the  operation  will  thus  be  materially  promoted. 
It  is  an  acknowledged  fact  that  the  patients  possessed  of 
moral  strength  endure  surgical  operations  and  their  con- 
sequences more  easily,  and  with  a  better  prospect  of  sur- 
mounting them,  than  those  who  are  of  depressed  spirits 
and  feeble  will. 

It  is  not  necessary  that  the  physician  himself  should 

8 


170  THE    SACRAMENTS. 

make  the  patient  aware  of  his  dangerous  condition.  This 
might  have  a  painful  and  injurious  effect.  Generally,  it 
will  be  most  prudent  to  impose  the  duty  on  the  relatives, 
or  on  those  in  the  house,  unless  there  should  be  a  knowledge 
or  a  suspicion  of  their  hindering,  rather  than  recommending, 
the  administration  of  the  sacraments  to  the  patient. 

Gury  says  that  a  physician  likewise  fulfils  his  duty, 
by  making  the  father-confessor  (or  the  parish-priest  ?) 
acquainted  with  the  danger  of  the  penitent,  in  order  that 
he  may  visit  the  patient,  et  efficaciits  movere  possit  ad  saluti 
animae  suae providendum.  Here  it  must  not  be  overlooked 
that  the  physician  not  unseldom  succeeds  better  in  making  a 
reluctant  patient  confess  than  the  priest  himself.  For  the 
patient  is  apt  to  think  that  the  priest  is  always  intent  on 
making  a  sick  person  confess,  even  when  there  is  no  real 
danger  to  life.  The  physician's  warning  on  this  head  he 
believes  much  more  easily.  A  sick  person  is  thus  often 
led  to  long  for  the  services  of  a  priest,  which,  a  short  time 
before,  he  would  not  so  much  as  hear  of. 

This  obligation  is  also  binding  on  the  physician,  even  in 
the  case  of  the  patient  who  is  in  danger  of  death  not  being 
a  Catholic.  The  danger  must  be  pointed  out  to  the  sick 
man  and  to  those  around  him,  in  order  that  he  may  pro- 
vide for  time  and  eternity  according  to  his  faith  and  his 
convictions. 

But  how,  if  the  Catholic  patient  is  attended  to  by  a 
physician  who  is  an  infidel  and  rationalist  ?  Such  a 
patient,  and  those  around  him,  are  obliged  to  ask  the 
physician  whether  there  is  danger,  and  to  call  in  the  priest 
for  precaution's  sake,  if  they  get  no  definite  and  satisfactory 
answer.  In  such  cases,  which  are  not  of  rare  occurrence 
in  populations  of  mixed  denominations,  the  priest  must 
visit  the  sick  as  soon  as  he  becomes  aware  of  the  case. 


OP   EXTREME    UNCTIOX.  171 

It  is  the  province  of  Pastoral  Theology  to  treat  of  this  sub- 
ject more  at  length.  One  more  suggestion  may,  however, 
be  mentioned  here.  It  is  certainly  the  wish  of  every 
priest  that  the  sick  of  his  parish  should  be  attended  by 
physicians  of  the  Catholic  faith.  Nevertheless,  he  should 
not  undertake  to  recommend  or  select  one  particular 
physician  out  of  a  number ;  for  the  least  imprudence 
herein  may  be  of  evil  consequences.  If  the  population  is 
mixed,  this  point  should  not  be  talked  of  in  public,  but  it 
should  be  left  to  private  conversation.  The  best  policy  for 
the  priest  is  not  to  meddle  with  this,  unless  he  is  directly 
consulted.  His  recommendations  or  selections  must  never 
be  done  so  as  to  discredit  special  particular  physicians. 
A  prudent  man  can  easily  give  an  evasive  answer  which 
will  hurt  no  one's  feelings,  nor  injure  any  one,  if  a  direct 
answer  should  be  inopportune.  He  can,  of  course,  should 
it  appear  to  him  desirable,  direct  the  choice  to  one  person, 
without  preferring  him  to  others.  He  may  say,  for  instance, 
'^  I  myself  am  treated  by  such  or  such  a  physician,  and  I 
am  well  satisfied,"  etc.,  etc.  But  if  a  priest  knows  that  a 
physician  of  loose  morals  practises  among  his  parishioners, 
by  whom  their  virtue  is  endangered,  not  only  has  he  the 
right  to  warn  his  people  against  this  danger  privatlmj  but, 
also,  it  is  his  duty  to  do  so ;  for  a  thief  within  is  more 
dangerous  than  one  from  without.  An  immoral  physician 
is  a  thief  inside  our  doors  as  regards  morals. 

The  personal  relations  between  priest  and  physician 
need  not  be  commented  on.  That  each  should  observe 
toward  the  other  what  social  etiquette  requires  in  well- 
bred  gentlemen,  is  all  that  can  be  expected.  If  both 
priest  and  physician  would  work  hand  in  hand  for  the 
welfare  of  the  congregation,  all  would  go  well  enough. 
It  would;  I  fear,  however,  be  Utopian  to  expect  such  a 


172  THE   SACRAMENTS 

state  of  things  ;  since  physicians  are  not  all  believers,  and 
priests  not  all  free  from  prejudices.  One  thing,  however, 
I  would  earnestly  recommend  to  the  clergy,  namely :  to 
work  harmoniously,  if  possible,  with  the  physician  for  the 
poor.  By  this,  the  pastor's  care  for  the  poor,  their 
education,  domestic  peace,  and  whole  well-being,  may  be 
advanced  in  a  high  degree.  I  speak  from  an  experience 
of  twelve  years  as  physician  for  the  poor,  in  a  district  of 
twelve  thousand  souls.  If  the  physician,  when  appointed, 
does  not  visit  the  clergyman,  the  latter  will  find  it  eminently 
beneficial  to  make  his  acquaintance  in  a  friendly  way, 
after  a  certain  period  of  time  has  elapsed.  Thus  both 
parties,  and  especially  the  poor  patients,  will  fare  the 
better.  Besides,  such  a  cooperation  would  be  of  service  to 
the  physician,  by  increasing  the  confidence  reposed  in  him, 
and  thus  lightening  the  burden  of  his  duties. 

Sometimes  poor  people  think  that  they  are  not  as  well 
treated  by  the  physician  appointed  for  them  as  are  those 
that  are  able  to  pay ;  that  he  is  restricted  from  pre- 
scribing for  them  expensive,  and  therefore,  in  their  eyes, 
better,  medicines,  etc.,  etc.  The  distrust  resulting  from  this 
prejudice  is  very  painful  to  the  doctor.  If,  moreover,  the 
most  arrogant  and  even  impudent  demands  are  made  on 
him,  with  the  remark  that  he  is  paid  for  what  he  does, 
all  love  for  his  practice  as  physician  of  the  poor  will  soon 
disappear,  and  he  will  try  to  get  rid  of  a  practice  so  exact- 
ing in  its  demands,  with  sure  ingratitude  for  its  reward, 
to  make  room  again  for  the  next  young  doctor.- 


OF   MATRIMONY.  173 

IV.—MATRIMONY. 

Here  we  have  only  to  speak  of  impotency.* 

Irapotency  is  an  impediment  which  renders  marriage 
null  and  void  {impedimentum  dirimens),  ^^  si  sit perpetua  et 
antecedatj  quia  matrimonium  consistit  in  mutua  traditione 
potestatis  corporis  ad  copulam  conjugalem  ;  hanc  autempotes- 
tatem  impotens  nan  potest  tradere,  cum  earn  non  liabeat. 

i^Porro  impotentia  in  viro  esse  censetur,  qiiando  est 
eunuchus,  vel  saltern  non  potest  seminare  in  vas  feminae  ; 
in  femina  vero,  qtiando  vel  seminare  non  potest  (si  verum 
est,  semen  feminale  requiri  ad  generationem),  vel  propter 
arctitudinem  non  potest  vlrum  pati  ant  ejus  semen  re- 
cipereJ^  (Liguori,  lib.  vi,  1095.) 

^^  Non  est  confundenda  cum  sterilitatej  steriles  enim  non 
sunt  ad  actum  conjugalem  impotentes :  Jiinc  valide  contra- 
hunt  (sc.  matrimonium)  senes,  qui  matrimonium  consummare 
valent ;  item  midieres,  quae  possunt  semen  exciperCj  etsi  illud 
non  retineanf'^  (Grury,  L  c,  tom.  ii,  pag.  831.) 

1. — On  the  part  of  the  husband  impotence  exists: — 

a)  If  both  testicles  are  absent.  This  is  the  case  with 
castrated  persons  and  cryptorchists.  In  the  latter,  the 
testes  have  not  descended  into  the  scrotum,  but  have 
remained  in  the  abdomen,  or  in  the  groin.  With  this 
there  is  generally  connected  a  total  wasting  away  of  the 
non-descended  testicles,  and  therefore  absolute  impotency. 

b)  If  he  have  testiculi  contusi,  as  they  are  termed  by 
the  moralists.  Hereby  certainly  is  meant  a  derangement 
of  the  testicles  by  which  they  become  inactive  (atrophy  of 
the  cellular  tissue).  This  atrophy  may  arise  from  in- 
flammation in  consequence  of  a  contusion,  also  through 

*  De  abusu  matrimonii,  vide  paginam  89  et  seqq. 


174:  THE    SACRAMENTS. 

hydrocele  (dropsy),  scrotal  hernia,  or  through  the  pressure 
of  tumors  on  the  scrotum  or  on  the  testicles  themselves. 
Sexual  excesses  likewise  may  cause  the  testicles  to  waste 
away.  Whether  the  testicles  are  inactive  or  not,  persons 
outside  of  the  profession  cannot  easily  know,  and  it  must 
be  ascertained  by  the  physician. 

c)  Absence  of  the  penis.  Besides  being  liable  to  be  lost  by 
accidents,  tumore,  and  by  necessary  operations,  it  may  also 
be  deficient  from  birth ;  and  such  deficiency  is  generally 
connected  with  other  malformations  of  the  genitals. 

d)  Want  of  development  A  merely  abnormal  small- 
ness  of  size  is  sometimes  congenital,  sometimes  it  is  the 
consequence  of  diseases,  ulcers.  Generally  this  deficiency 
exists  together  with  deficient  formation  of  the  urethra, 
where  the  end  of  the  urethra  does  not  come  to  the  end  of 
the  penis,  but  opens  underneath  (hypospadiasis),  or  on 
the  top  of  the  penis  (epispadiasis),  somewhere  in  its 
structure,  or  even  just  at  the  base  of  it,  close  to  the  body. 
In  the  worst  instances  of  this  malformation  injcctio  in  vas 
feminale  is  impossible.  But  still  such  men  have  been 
fathers  j  even  hereditary  hypospadiasis  has  been  observed 
for  several  generations.  In  such  cases  rffusio  seminis  in 
introifum  vaginae  was  sufficient  to  effect  impregnation. 
The  old  idea,  that  it  is  only  the  odor,  or  aura  seminalis^ 
'that  effects  impregnation,  or  that  the  latter  takes  place 
through  effusio  seminiSy  say  on  the  abdominal  walls,  is,  of 
course,  entirely  fabulous.  Such  fables  have  been  invented 
in  order  to  cover  the  real  matter  of  fact,  and  have  been 
believed,  partly  from  a  certain  love  of  the  miraculous, 
partly  from  want  of  correct  physiological  knowledge.  So 
much  is  certain^  even  at  this  day,  that  impregnation  may 
take  place,  if  the  semen  is  deposited  on  any  part  of  the 
mucous  meinlrane  of  the  vaginUy  even  on  that  part  which 


OF  MATRIMONY.  175 

may  be  reached  by  the  semen  without  any  real  penetratio 
in  vaginam.  And  even  then,  if  the  hymen  virginale  is  un- 
broken, impregnation  is  not  impossible  in  this  manner.  In- 
asmuch as  ejaculatio  seminis  in  os  seu  introitum  vaginae 
is  yet  possible,  even  when  there  is  want  of  development, 
or  perhaps  even  total  deficiency  of  the  penis,  such  persons 
cannot  be  considered  as  impotent.  Under  these  circum- 
stances the  case  may  occur  that  the  husband  is  able  ad 
ejaculandum  semen,  impregnation  following,  although  real 
copula  is  impossible.  The  first  and  primary  end  of  mar- 
riage and  of  copula  is  then  fulfilled,  but  the  other  end, 
gratificatio  volujotatis,  remains  unaccomplished  on  the  part 
of  the  wife.  As  the  marriage  cannot  perhaps  be  dissolved, 
the  possibility  of  impregnation  having  been  proved  through 
an  impregnation  effected,  I  think  this  to  be  one  of  the  cases 
where  the  wife  may  be  a\lo\v edpropterp)ericulum  incontinen- 
tiae,  statimpost  copulam  resp.  post  viri  seminationem  seipsam 
ad  seminationem  excitare. 

e)  Inipotentia  ex  friglditatej  '' quando  conjuges  oh  hanc 
causam  omnino  pcrficere  nequeunt  copulam  aptam  ad 
generationem,^^  is,  according  to  canon  law,  a  reason  for 
dissolving  marriage,  after  an  experience  of  three  years 
has  elapsed.  This  affection  may  occur  in  marriages  con- 
tracted for  the  sake  of  convenience  and  speculation ; 
likewise,  from  the  first  discovering  after  marriage  some 
disagreeable  deformity  or  loathsome  disease.  Abom'matio 
viri  erga  mulierem  may  be  so  great  that  he  never  experi- 
ences necessariam  excitationem  ad  copulam.  If  the 
morbus  vel  deformitas  is  incurable,  and  if  the  frigiditas 
caused  thereby  cannot  be  overcome,  the  Church  certainly 
acts  kindly  and  justly  in  separating  such  unfortunates. 
In  case  of  callditas  siiperfluaj  ob  quam  vir  semper  seminet 
extra  vaSj   antequam  possU  penetrarcy  the  moralists  also 


176  THE   SACRAMENTS. 

require  experientiam  trienii.  This  period  will  generally 
be  t  ufficient  to  overcome  tliis  affection.  In  most  of  these 
cases  seminationis  ante  pe^zdrationcm,  the  cause  is  more 
a  state  of  intirmitj  than  calidltas  superflua.  This  Avas 
probably  the  reason  of  requiring  triennial  experience. 
Calidltas  supei-ftua  proper  decreases  generally  very  soon. 
It  cannot,  I  think,  be  considered  an  impediment  to  mar- 
riage, because  instances  of  this  affection  are  by  no  means 
rare,  and  are  overcome  just  as  quickly  as  they  are  frequent. 
In  affections  of  debility,  which  cause  seminationem  ante 
pcnetratmiem,  the  demand  of  triennial  experience  is 
eminently  proper.  They  arise  partly  from  depression  of 
spirits,  partly  from  a  local  over-irritability  of  the  parts, 
caused  perhaps  by  previous  excesses ;  and  they  are  relieved 
generally  through  the  calming  influence  of  marriage-life 
and  by  proper  treatment. 

2. — Impotentia  on  the  part  of  the  wife  exists,  if  there 
is  total  absence  of  the  vagina,  or  complete  or  partial 
(specialiter  in  introitu)  narrowness  of  the  same,  so  that 
penetratio  in  vas  is  impossible.  Here  marriage  cannot 
be  consummated,  unless  an  operation  be  performed  which 
is  dangerous  to  life,  or  brings  at  least  danger  of  grave 
sickness. 

Absence  of  the  vagina  is  sometimes  congenital  j  some- 
times it  is  connected  with  other  malformations  of  the  parts  ; 
sometimes  the  latter  are  normal  in  all  other  respects.  In 
the  latter  case,  the  individual  generally  does  not  survive 
the  age  of  puberty  very  long ;  in  the  former  case,  there 
exists,  of  course,  absolute  impotency. 

Narrowness,  and  partial  or  total  closure  of  the  vagina,  is 
often  found  at  birth,  though  it  may  be  produced  by  vari- 
ous causes  afterward,  such  as  tumors,  inflammations,  etc. 
A  complete  closure,  while  the  functions  of  the  parts  are 


OF  MATRIMONY,  177 

in  other  respects  normal,  must  be  remedied,  or  dangerous 
affections  will  arise.  As  long  as  the  closure  exists,  it  pre- 
vents consummatioiiem  matrimonii^  unless  it  is  at  the  other 
end,  near  the  uterus,  when  penetratio  usque  act  impediment 
turn  is  possible.  (Compare  below  on  absence  of  the  uterus.) 

Narrowness  may  exist  in  the  whole  length,  or  only  in  a 
particular  part,  of  the  vagina.  Copula  becomes  impossible, 
if  there  is  considerable  stricture  of  the  whole  vagina  or  of 
the  introitus.  Nevertheless,  impregnation  is  then  possible, 
as  is  proved  by  cases  recorded  in  which  the  stricture  had  to 
be  operated  on,  before  delivery  could  be  accomplished  f  for, 
seminatio  viri  may  take  place  sine  penetratione.  Nearly 
all  such  cases  of  stricture,  especially  if  only  particular 
parts  {introitus  included)  are  concerned,  can  be  corrected 
by  a  slight  operation.  Many  such  cases  are  rectified  by 
continued  attempts  ad  copidam.  Before  marriage  could 
be  dissolved,  it  would  be  necessary,  therefore,  to  have 
the  testimony  of  competent  authority  as  to  whether  the 
stricture  is  capable  of  being  rectified  without  danger  or  not. 
A  certain  stricture  which  renders  the  copula  impossible, 
called  vaginismus^  that  is,  a  spasmodic  constriction  of  the 
sphincter-muscle  of  the  vagina  at  each  attempt  of  copula, 
and  even  at  every  touching,  is  quite  frequent.  This  affec- 
tion can  be  corrected  without  danger. 

Here  the  question  arises,  whether  there  is  an  obligation 
on  the  part  of  the  wife  to  undergo  an  operation  which  is 
troublesome  and  painful,  but  not  dangerous  to  life,  in  order 
to  become  apta  ad  coptdam,  St.  Alphonse  (lib.  vi,  1099) 
answers  in  the  affirmative :  ^^  Quia  ad  id  videtur  midier 
oUigari  vi  contractus^  cum  id  necessarium  sit  ad  servandum 
jus  copidaCj  quod  in  virmn  transtuUt.^^  He  proceeds : 
^' Haec  quidem  sententia  est  communior,  et  probdbilior 
videtur  speculative   loquendo ;    sed  practice  hquendo  valde 


178  THE   SACRAMENTS. 

prohahile  est,  quod  ait  Cone.  Tourn.  he.  cit.  etim  PonfaSy 
7iem;pe  quod  si  ineisio  non  posset  fieri  nisi  per  manns 
chiriirgi,  non  tenetur  mnlier  liane  incls'wnem ptati  eum  tanta 
vereciindiaj  quod  esset  onus  plus  quam  gravissimum ;  si 
enim  puella  non  tenetur ,  nee  etiam  ad  servandam  sibi  vitaiUy 
in  aliquo  morbo  vereeundo  eliirurgi  maniim  pati  (juxta  dicta 
lib.  ivy  372)^  quomodo  ad  id  tenehitur,  itt  ad  usum  eonjugii 
aptam  se  reddat  f  Quid  enim  turpius  {ait  Collet,  ibid.) 
quam  ut  virgo  nuda  oculis  et  manibus  eliirurgi  suhjieiatur, 
et  incisionem  foedam  simul  ae  gravem  pati  cogatur  f' 

Before  the  marriage  is  really  contracted,  such  an 
obligation  does  not,  of  course,  exist.  But,  afterward, 
modesty  alone  does  not  seem  to  me  sufficient  reason  for 
refusing  the  operation — all  danger  of  life  being  excluded. 
I  acknowledge  that  a  virgo  is  not  obliged  7iec  etiam  ad 
vitam  sibi  servandam  to  put  aside  vereeundiam  ;  but  in  the 
supposed  case  it  is  different,  because  the  rights  of  another 
person  have  to  be  considered.  The  vis  eontraetus  [seeluso 
mortis  perieuh  aid  gravi  eorporali  pericuh),  as  Liguori 
himself  says  (1.  c),  binds  the  wife,  ^^  cum  gravi  molest ia 
et  dolore  reddere  se  aptam  ad  eopidamJ^  Now,  how  can  the 
vereeundia  alone  be  sufficient  to  exempt  her  from  this 
obligation  toward  her  husband,  who  is  entitled  to  it  by 
the  contract  ? 

Another  kind  of  impotency  on  the  part  of  the  wife, 
which^is  not  mentioned  by  the  moralists,  as  far  as  I  have 
been  able  to  discover,  and  which  probably  would  be 
classed  by  them  under  sterility,  is  the  absence  of  the 
iderus,  or  the  absolute  closure  of  the  vagina  near  the 
uterus,  as  said  above.  It  does  not  prevent  the  copula, 
though  it  does  absolutely  prevent  conception.  An  eunuch 
may,  under  certain  circumstances,  also  consummate  the 
copula  cum  completa  voluptate  venerea  for  both  parties.     At 


OF  MATRIMONY.  179 

this  copula  there  is  no  ejectio  semiizis  (but  only  mucus 
from  the  prostate  gland,  etc.)  j  hence  the  copula  is  natura 
sua  inapta  ad  generationem.  If  the  uterus  is  absent,  the 
copula  is  on  the  part  of  the  husband,  but  not  on  the  part 
of  the  wife,  natura  sua  apta  ad  generationem.  If,  there- 
fore, such  a  defect  is  known,  there  can  be  no  doubt  that 
the  copula  is  to  no  purpose  quoad  generationem.  I  shall 
be  answered  that  this  is  only  accidentally  so,  and  that 
exactly  the  same  takes  place,  as  in  the  case  of  copula, 
tempore  gcstationis.  But  there  is  this  difference,  that 
this  sterilitas  ahsoliita^  in  consequence  of  absence  of  the 
uterus,  is  lasting,  while  the  accidental  unfitness  of  copula 
tempore  gestationis  is  only  passing.  Besides,  the  former 
is  antecedent,  the  latter  is  not.  But  this  is  a  point  which 
the  moralists  must  decide,  as  I  am  not  competent  to  do  so. 

Finally  Liguori  says  :  ^^  In  femina  impotentia  esse  cen- 
setur,  quando  (ilia)  seminare  non  potest,  si  verum  est,  semen 
feminale  requiri  ad  generationem.^^  As  there  is  no  such 
necessity,  this  kind  of  impotency  does  not  exist. 

8. — Relative  impotency  exists  oh  misadaptationem  geni- 
talium,  si  vagina  feminae  angustior  est  partihiis  viri,  dum 
amho  matrimonio  uti  possint  cum  aliis.  Generally  adaptatio 
vaginae  may  be  expected  in  such  cases  from  repeated 
attempts,  unless  the  stricture  is  very  great,  or  unless  there 
is  much  induration  of  the  tissues  (for  instance,  in  con- 
sequence of  scars),  or  unless  the  abnormal  enlargement  .of 
the  partes  viriles  (for  instance,  in  elephantiasis)  is  too 
considerable.  Experientia  triennii  is  therefore  admissible 
in  such  cases. 

4. — Are  hermaphrodites  impotent?  Liguori  (lib.  vi, 
1095)  says:  '^  Valide  contrahunt :  1.  Steriles  ...  2.  Her- 
maphroditi,  quia  vere  smit  potentes  ad  usum  matrimonii. 
Et  quidem,  si  alter  sexus  emineat,  secundum  ilium  tantum 


180  THE    SACRAMENTS. 

valebit :  si  uterque  sit  par,  optio  illis  datuTj  tit  utrdlihet 
titantur,  ita  tamen  ut  quern  semel  elegerint,  semper  retineant.'^'' 
There  is  no  necessity  to  be  more  explicit  on  this  difficult 
point  of  hermaphroditism.  Nearly  all  such  cases  are,  on 
examination,  of  one  sex,  even  should  the  general  appear- 
ance and  the  external  parts  appear  to  be  half-male,  half- 
female.  Ver}^  few  cases  are  recorded,  wherein  an  exact 
examination  (post  mortem)  showed  either  one  testicle  and 
one  ovary,  or  on  both  sides  one  testicle  and  one  ovary. 
The  latter  cases  only  can  be  concerned  here.  I  could 
not  find  any  observation  made,  whether  such  real  her- 
maphrodites are  productive.  Procreative  power  cannot  be 
presumed,  because  there  is  always  in  such  cases  a  great 
deformity  of  the  external  parts.  In  practice,  the  question 
of  impotency  as  an  impediment  to  marriage  is  of  rare 
occurrence,  because  few  such  hermaphroditic  individuals 
reach  the  age  of  puberty.  Should  such  a  case  occur,  recur- 
rence must  be  bad  to  medical  examination  de  sexu  et  de 
potentia. 


E— AFPECTIONS  A^^D  DISEASES  DANGEROUS 
TO  LIFE. 

There  is  no  doubt  of  the  benefit  arising  to  the  priest  in 
the  care  of  souls  from  a  knowledge  of  what  affections  and 
diseases  are  dangerous  to  life,  and  what  are  not  so.  It  is 
a  very  difficult  task  to  be  very  accurate  in  this  matter,  and 
to  say  all  that  is  necessary  for  the  priest  to  derive  the  proper 
advantage  from  it  without  preliminary  medical  information. 
Nevertheless,  I  propose  to  make  the  trial.  It  cannot,  of 
course,  be  my  purpose  to  enumerate  all  the  diseases  and 
accidents  from  which  death  might  follow.  I  have  to  con- 
fine myself  to  naming  the  principal  groups  and  the  most 
frequent  forms  of  disease — respectively  speaking,  causes  of 
death.  Nor  can  I  explain,  in  the  case  of  every  single 
malady,  how,  when,  and  under  what  circumstances,  death 
ensues.  Here,  also,  general  hints  must  suffice.  My  com- 
pilation will  be  of  profit  to  the  priest,  perhaps,  only  in  so 
far  as  it  will  make  him  less  likely  to  omit  any  duty  of  his 
office  through  the  negligence  of  others,  his  own  attention 
being  aroused  to  the  possible  or  probable  danger.  I  have 
used,  at  the  same  time,  the  technical  terms,  because  the 
priest  should  know  the  more  important  ones,  as  he  may 
hear  them  often,  and  perhaps  them  only,  for  instance, 
through  the  physician. 

In  addition  to  this  compilation  of  dangerous  diseases,  I 
will  try  to  point  out  the  symptoms,  discernible  to  unpro- 
fessional persons,  which  show  the  disease  to  be  serious  and 


182  DISEASES   DANGEROUS   TO    LIFE, 

dangerous  ;  the  symptoms  whose  presence  always  indicates 
the  approach  of  death;  and^  finally,  those  of  death  having 
taken  place. 

Among  acute  diseases,  first,  lesions  of  the  principal 
organs  are  attended  with  danger  to  life.  Injuries  of  the 
head,  violating,  crushing,  or  perforating  the  bony  case  of  the 
skull,  or  lesions  of  the  brain  and  its  membranes  {meninges). 
Concussion  of  the  brain  through  falls  or  blows — commotio 
cerehrij  etc.  Rupture,  dislocation  of  the  bony  spinal 
column,  with  lesion  and  concussion  of  the  spinal  marrow. 
Severe  injuries  to  the  neck,  with  lesions  of  the  windpipe 
and  oesophagus,  or  of  one  or  more  of  the  large  vessels. 
Wounds  perforating  the  cavity  of  the  chest  or  of  the 
abdomen,  with  or  without  lesion  of  the  organs  contained 
within.  Severe  bruises  of  the  chest  or  of  the  abdomen, 
which  are  often  accompanied  by  internal  lacerations  and 
malignant  luxation  (fracture),  for  instance,  of  the  bones  of 
the  pelvis.  Total  crushing  or  tearing  away  of  limbs,  and 
injuries  to  bones,  in  complication  with  external  wounds. 
Lesions  of  large  arteries.  All  such  injuries  may  be  fatal, 
either  immediately  or  quickly,  or  they  may  afterward 
terminate  in  death  through  excited  inflammation. 

Acute  inflammation  of  the  vital  organs,  from  any  cause, 
is  prominent  among  the  causes  of  death.  Inflammation 
of  the  brain  and  its  membranes,  encephalitis,  meningitis  / 
of  the  bronchial  tubes  (in  infants  and  old  people),  bronchitis  ; 
of  the  lungs,  of  the  pleura  (serous  membrane  which  lines 
the  cavity  of  the  chest),  imcumonia  or  lung-fever,  pleurisy 
or  pleuritiSy  pleuropneumonia  ;  acute  consumption,  or  acute 
pulmonary  tuberculosis  ;  inflammation  of  the  sac  of  the 
hdRYt,  pericarditis  ;  of  the  lining  membranes  of  the  heart- 
cavity,  endocarditis  ;  of  the  peritoneum  (serous  membrane 
which  lines  the  abdominal  cavity)  in  its  diflferent  parts, 


DISEASES   DANGEROUS   TO   LIFE.  183 

peritonitis  ;  of  the  liver,  hepatitis  ;  of  the  kidneys,  nephritis^ 
Bright's  disease  : — all  of  these  produce,  more  or  less  often, 
fatal  consequences. 

To  these  may  be  added  a  certain  number  of  epidemic 
and  contagious  diseases.  Small-pox,  variola  vera,  some- 
times also  varioloid  ;  Asiatic  cholera ;  in  infants  and  feeble 
old  people  also,  cholerine ;  dysentery,  dysenteria  ;  typhoid 
fever,  typhus  ahdominalis  ;  relapsing  or  famine-  or  spotted- 
fever,  typhus  exaiithcmaticiis  /  pernicious  intermittent  fever, 
intermittens  perniciosa  ;  diphtheria,  diphtheritis  ;  puerperal 
fever,  fehris  puerj^eralis  ;  measles,  morhilU  ;  scarlet-fever, 
scarlatina;  whooping-  or  chin-cough,  tiissis  convulsiva^ 
pertussis^ — are  generally  fatal  in  infants,  seldom  in  grown 
people. 

Amongst  acute  diseases  endangering  life,  must  also  be 
named  seizures  of  apoplexy  ;  severe  sunstroke,  insolatio  ; 
croup  of  the  larynx,  laryngitis  crouposa  or  pseudomem- 
hranacea  /  perforation  of  the  intestines,  invagination ; 
strangulated  liernia,  hernia  incarcerata ;  acute  retention 
of  urine,  especially  in  old  people ;  acute  rheumatism  of  the 
joints,  rheumatismus  articidorum  acutus  ;  erysipelas  seated 
upon  the  head  and  face,  and  erysipelas  migrans,  which 
has  the  tendency  to  advance  over  almost  every  part  of 
the  surface  ;  trismus,  or  locked-jaw,  tetanus ;  general 
convulsions  of  infants,  and  of  women  during  pregnancy 
and  labor,  eclampsia  infantium  et  parturicntium  ;  hydro- 
phobia, and  cases  of  poisoning  from  glanders,  nKi]i,L;u:int 
anthrax  or  murrain,  and  from  poison  developed  in  corpses 
and  through  violent  mineral  and  vegetable  poisons  •, 
pyaemia  (poisoning  of  the  blood  through  absorption  of  pus 
from  wounds,  etc.) ;  gangrene,  first  state  of  mortification, 
gangraena.  Finally,  profuse  bleeding  from  the  nose, 
lungs,  stomach,  womb,  etc. 


1S4  DISEASES   DANGEROUS   TO   LIFE. 

Besides  the  acute  diseases  which  suddenly,  or  in  a  few 
days  or  weeks,  come  to  a  fatal  issue,  the  chronic  diseases 
are  none  the  less  angels  of  death.  Perhaps  just  as  many 
die  of  chronic  as  of  acute  diseases.  Of  course,  deaths  are 
not  herein  included  arising  from  violence,  whether  resulting 
from  accident  or  from  the  casualties  of  war. 

Nearly  all  inflammatory  disorders  may  assume  a  chronic 
character.  Those  which,  in  the  acute  form,  tend  to  a  fatal 
issue,  lead  as  surely  to  death  in  the  chronic  form,  although 
more  slowly.  Death  then  takes  place  through  the  general 
exhaustion  of  the  organism,  unless  life  is  ended  sooner 
by  some  complication  :  a  result  which  often  takes  place 
suddenly.  The  general  exhaustion  of  the  vital  powers  is 
due  (apart  from  losses  of  vital  fluids)  to  the  deficient  supply 
of  the  necessary  ingredients  for  life,  and  to  the  inability 
of  the  organs  to  recruit  the  bodily  powers  by  appropriating 
the  same.  Nutriment  and  oxygen  cannot  be  sufficiently 
absorbed  and  appropriated  by  disordered  organs  of  diges- 
tion and  respiration.  Hence,  the  chronic  disorders  of  these 
organs  form  two  important  groups  of  causes  of  death.  The 
third  group  is  formed  by  disorders  of  the  nervous  centres, 
the  brain  and  spinal  cord ;  the  fourth  by  disturbances  of 
circulation  (diseases  of  the  heart),  and  by  profound  changes 
in  the  chemical  and  vital  properties  of  the  blood  (diseases 
of  the  liver  and  of  the  kidneys,  cancer  of  the  different  parts, 
tuberculosis,  malaria,  etc.).  When  a  chronic  disease  will 
end  in  death,  is  often  very  difficult  to  say.  It  is  of  frequent 
occurrence  that,  of  two  sick  persons  whose  cases  are  to  all 
appearances  alike,  one  dies  much  sooner  than  the  other 
without  any  discernible  cause.  Even  the  post-mortem  ex- 
amination does  not,  in  many  cases  of  sudden  and  unexpected 
death  during  chronic  diseases,  disclose  what  was  just  then 
and  there  the  cause  of  death. 


DISEASES    DANGEROUS   TO    LIFE.  185 

Hence  it  follows  that  the  medical  attendant  cannot 
always  foretell  with  certainty  whether  the  death  of  a 
person  sufFeriiig  from  chronic  disease  is  near,  or  yet  remote. 
As  a  general  rule,  precautions  should  be  taken  in  chronic 
diseases,  if  there  is  general  decline  of  the  vital  powers,  or 
if  specially  alarming  symptoms  make  their  appearance. 


'F— SIGNS    SHOWING  THE  DISEASE  TO  BE 
SERIOUS  AND  DANGEROUS  TO  LIFE. 

Sometimes  the  priest  can  obtain  no  otlier  information 
about  the  disease  and  its  danger  than  that  furnished  by 
his  own  observation.  Such  cases  are  of  frequent  occur- 
rence in  the  country,  and  may  often  enough  happen  even 
in  cities.  For  instance,  the  priest  may  not  find  an  oppor- 
tunity of  questioning  the  physician,  or  the  physician  may 
not  deem  it  necessary  or  expedient  to  .make  any  particular 
communication  to  the  relatives.  Now  it  is  quite  possible 
for  the  priest  to  have  sufficient  knowledge  of  certain 
symptoms  to  enable  him  to  suspect,  at  an  early  stage  of 
the  disease,  any  danger  to  life  before  it  becomes  an 
immediate  one.  It  is  in  the  highest  degree  desirable  that 
he  should  be  in  possession  of  this  knowledge.  Hence  the 
object  of  this  chapter  is  to  assist  the  priest  in  detecting, 
himself  the  dangerous  character  of  a  disease,  from  certain 
signs  and  conditions  easily  discernible  to  the  non-profes- 
sional eye.  These  signs,  however,  show  nothing  more  than 
that  there  exists  a  dangerous  disorder,  or  disorders,  if  there 
are  more  than  one,  in  the  organism.  They  do  not  at  all 
indicate  the  disease  from  which  the  sick  man  is  suff"ering ; 
still  less  do  they  afford  any  indication  of  what  remedies 
should  be  employed.  Neither  diagnosis  nor  therapeutics 
belong  to  the  province  of  the  priest.  It  is  sufficient  for 
him  to  know  whether  such  or  such  a  disease  exhibits 
symptoms  of  a  nature  dangerous  to  life. 


SIGNS   OF  DISEASES   DANGEROUS   TO   LIFE.  187 

Symptoms  which  show  the  disease  to  be  serious  and 
attended  with  danger  to  life,  are  : — 

1 .  Great  variations  in  the  temperature  of  the  body,  and 
in  the  subjective  sensations  of  the  same.  They  always 
indicate  serious  disturbance.  The  natural  standard  of 
heat  in  the  human  body  (measured  by  the  thermometer 
placed  in  the  armpit)  is  37°  C,  or  about  100°  F.  In- 
crease of  the  temperature  above  39.5°  C,  if  continuing 
for  some  days,  always  denotes  gravity  of  the  disorder, 
especially  if  the  temperature  does  not  sink  at  all,  or  not 
much,  in  the  morning.  Death  is  imminent,  if  the  tempera- 
ture remains  for  any  length  of  time  above  the  point  from 
40.5°  to  41.5°  C.  In  chronic  diseases,  even  a  moderate 
rise  of  temperature  is  an  unfavorable  symptom  :  should  it 
continue,  it  indicates  the  progress  of  exhaustion. 

As  a  thermometer  is  not  always  at  hand,  the  estimate 
of  temperature  must  often  be  made  by  the  touch.  A 
great  increase  of  heat  is  quite  perceptible  to  the  hand 
placed  on  the  skin,  and  causes  a  burning  sensation, 
generally  that  of  dry  heat.  This  sensation  may  become 
pricking,  if  the  temperature  is  very  high  {color  mordax). 
Cases  very  rarely  end  favorably  when  this  symptom  is 
found. 

The  subjective  sensation  of  warmth  is  generally  in- 
creased in  proportion  to  the  increase  of  heat.  If  high 
temperatures  are  not  felt  as  such  by  the  patient,  the  activity 
of  the  sensorium  (brain)  is  disturbed.  This  is  an  unfavor- 
able symptom.  With  regard  to  a  feeling  of  cold,  of  chills, 
when  there  is  objective  heat,  see  farther  on. 

Subjective  feeling  of  heat,  when  an  objective  elevation 
of  the  temperature  cannot  be  proved,  is  not  an  unfavorable 
symptom  except  in  Asiatic  cholera,  where  this  symptom 
shows    that  the  patient  has  passed  into  a  typhoid   state 


188  SIGXS   OF   DISEASES 

(cholera- typhoid),  and  where  it  is.  therefore,  a  premonition 
of  a  new  and  dangerous  condition.  Again,  when  there 
are  profuse  inward  bleedings  from  inner  lacerations,  the 
sensation  of  heat  is  increased  at  the  place  where  the  blood 
escapes,  although  objectively  no  augmentation  of  tempera- 
ture be  perceptible  j  or,  rather,  a  lower  temperature  of  tho 
skin  may  ensue. 

Objective  lowering  of  the  temperature  of  the  body 
occurs  only  in  grave  disturbances.  Very  striking  in 
cholera,  it  is  also  met  with  in  profuse  losses  of  blood, 
in  dropsical,  paralytica!  affections,  etc.  If  the  temperature 
suddenly  lowers  during  acute  diseases,  it  is  a  sign  of 
approaching  death.  Again,  if  the  temperature  falls  below 
the  natural  standard  in  the  stage  of  exhaustion  in  chronic 
diseases,  it  is  indicative  of  approaching  death. 

Generally,  when  the  thermometer  shows  a  decline  in 
the  heat  of  the  body,  the  patient  also  experiences  a  sen- 
sation of- cold.  The  latter  is,  however,  not  unfrequently 
the  case,  when  there  is  a  rising,  or  at  least  no  falling,  in 
the  temperature ;  as  in  shiverings  and  chills.  Fevers, 
even  slight  ones,  commence  generally  with  a  chill,  or 
shuddering.  Here  the  chilly  sensations  have  no  special 
significance  for  the  prognosis,  but  if  they  recur  often,  or 
if  they  are  renewed  during  the  progress  of  the  disease, 
they  denote  an  aggravation  or  a  complication,  and  are 
therefore  symptomatic  of  danger  {pyaemia^  uraemia.) 

2.  Notable  changes  in  the  general  feeling  that  cannot 
be  traced  to  psychical  causes,  dulness,  indifference,  or 
great  uneasiness,  accompanied  with  anguish,  restlessness, 
and  whining  fits,  are  circumstances  denoting,  generally, 
serious  constitutional  disturbance. 

3.  Awkwardness  of  movement,  constantly  lying  on  the 
back,  with  a  tendency  to  sink  to  the  bottom  of  the  bed,  aro 


DANGEROUS   TO    LIFE.  189 

symptoms  attending  grave  fevers,  and  are  due  to  serious 
sympathetic  disturbance  of  the  central  nervous  system. 

4.  Pain,  on  account  of  its  subjective  difference  in  this 
or  that  individual,  is  not  a  symptom  from  which  unpro- 
fessional persons  can  justly  infer  danger  to  life.  So  much 
only  is  worth  knowing,  that  the  sudden  or  very  quick 
disappearance  of  pain  must  be  dreaded  in  cases  in  which 
there  is  no  moderation  of  the  coexisting  fever,  and  where 
the  progress  of  exhaustion  indicates  that  the  relief  of  pain 
does  not  result  from  the  removal  of  its  cause,  but  from  the 
weakening  of  the  perception  of  it. 

5.  The  condition  of  the  skin : — If  the  skin  assumes  a 
very  pale  or  earth-colored,  or  a  dusky-grey  or  a  yellow- 
ish, hue,  it  is  a  symptom  of  great  disturbance  in  the 
nutritive  functions.  Lividity,  or  blueness,  over  the  whole 
surface  occurs  in  cholera,  and  during  the  so-called  cold 
stage  of  an  intermittent  fever  ;  if  marked  in  the  face, 
especially  over  the  lips  and  cheeks  and  on  the  lingers,  it 
denotes  deep  disorder  of  the  circulation. 

'  Dryness  of  the  skin  is  always  an  unfavorable  symptom. 
If  it  is  constantly  very  hot  and  dry,  the  disease  tends  to 
an  unfavorable  issue. 

Increased  sweats,  especially  profuse  and  continuous 
night-sweats,  indicate,  in  chronic  diseases,  a  low  condition 
of  the  system.  Cold  sweats  are  always  unfavorable, 
especially  in  acute  febrile  diseases.  In  chronic  diseases, 
when  there  is  at  the  same  time  great  exhaustion,  they  may 
be  considered  as  symptoms  of  the  approaching  agony. 

6.  Dropsy,  general  or  local,  denotes  great  constitutional 
disorder.  Should  it  appear  quickly  during  acute  diseases, 
it  generally  denotes  a  speedily  fatal  issue.  The  sudden 
disappearance  of  long-continued  swellings  often  indicates 
a  hasty  disgolution. 


190  SIGNS   OF  DISEASES 

7.  General  and  extreme  emaciation  is  due  to  deep  dis- 
turbance of  nutrition,  and,  in  chronic  diseases,  it  is  a  sign 
of  approaching  death. 

8.  General  convulsions,  also  convulsions  of  particular 
limbs,  tremors,  denote  disturbance  in  the  central  nervous 
s^^stem.  If  they  continue  for  any  length  of  time,  or  if  they 
return  often,  the  disturbance  is  of  a  grave  character  and 
may  lead  to  a  rapidly,  and  even  suddenly,  fatal  issue. 
Real  epileptic  attacks  terminate  often  in  death.  But 
hysterical  convulsive  attacks,  local  or  general,  very  seldom 
prove  dangerous. 

9.  Twitching  of  the  tendons,  picking  of  the  bed-clothes, 
an  uncertain  wandering  of  the  hands  on  the  bed,  as  if 
seeking  for  or  grasping  at  something,  often  with  closed 
eyes,  or  with  a  vacant  and  confused  stare,  are  always  to 
be  dreaded. 

10.  Paralysis  affecting  single  extremities,  or  the  face 
on  one  side,  one  side  of  the  body  ijiemiplegia),  or  the 
lower  half  of  the  body  •  also  paralysis  of  certain  muscles, 
especially  of  the  sphincter-muscles  of  the  openings  of  the 
body,  are  symptoms  of  danger.  Involuntary  evacuation 
of  the  faeces  and  urine  portend  the  paralysis  of  the  re- 
spective sphincter-muscles. 

11.  Sores  and  sloughs  on  parts  on  which  the  body  rests, 
for  instance,  the  thighs,  the  lower  part  of  the  back,  heels, 
etc.,  denote  an  advanced  state  of  exhaustion,  and  are  bad 
symptoms. 

12.  Hurried  pulse,  above  130  beats  in  the  minute  (in 
adults) ;  doable  (dicrotic),  irregular  or  unequal,  small, 
weak,  wiry,  easily  compressible,  pulse. 

13.  If  the  mouth  stands  open,  sometimes  attended  with 
involuntary  flow  of  saliva ;  if  the  angles  of  the  mouth  are 
strongly  drawn   to   one   side;   if  the   lips   become   much 


DANGEROUS   TO   LIFE.  191 

emaciated,  or  sunken  and  thin,  and  assume  a  pale  or  livid 
hue ;  or  if  the  lips,  teeth  and  gums^  tongue,  nostrils,  are 
covered  with  a  thick,  brown,  rust-colored  coating  or  fur  : — 
all  these  are  symptoms  of  deep  disorder,  and  threaten 
speedy  dissolution.  Again,  sinking  of  the  temples,  or  if 
the  ears  are  getting  thin  or  withered ;  if  the  nose  seems 
pointed  and  thin,  or  is  drawn  to  one  side ;  sinking  or  im- 
movable condition,  or  rolling  and  turning  of  the  eyes ; 
profuse  shedding  of  tears  ;  squinting,  not  previously  exist- 
ing ;  double  vision ;  indifference  of  the  pupils  to  light ; 
unequalness  of  the  pupils ;  clouding  before  the  eyes ;  dim- 
ness and  impairment  of  the  senses  of  sight  and  hearing, 
and  of  the  senses  in  general : — all  these  symptoms  denote 
extreme  danger. 

14.  Symptoms  arising  from  exhaustion  of  the  brain,  as 
sluggishness  of  perception  and  of  the  intellectual  faculties  ; 
loss  or  impairment  of  memory ;  sleep  from  which  the 
patient  can  be  aroused,  but  immediately  relapses ;  coma 
(morbid  disposition  to  sleep)  5  lethargy  (deep,  unnatural 
sleep,  from  which  it  is  very  difficult  to  awaken  a  person) ; 
constant  sleeplessness  and  delirium : — indicate  increased 
irritability,  are  symptoms  of  disturbance  of  the  brain, 
and  are  formidable  symptoms. 

15.  Increased  frequency  of  respiration  occurs  in  pulmo- 
nary affections  of  a  graver  character,  and  in  diseases  of  the 
heart  during  the  last  stages.  Normal  respiration  is  from 
twenty  to  twenty-five  times  a  minute.  Accelerated  breath- 
ing of  thirty-five  and  more  (as  many  as  sixty)  respirations  in 
a  minute  is  a  symptom  of  grave  disease.  Also,  in  grave 
disorders  of  the  organs  of  the  chest,  breathing  is  either 
excessively  labored,  with  great  dilation  of  the  nostrils 
and  violent  exertion  of  the  muscles  of  the  neck  ;  or  it  is 
small  and  feeble,  so  that  the  inspiration  is  short  and  broken 


192  SIGNS   OF  DISEASES 

off,  while  the  expiration  appears  prolonged  at  the  expense  of 
inspiration.  Extreme  difficulty  of  breathing,  or  orthopnoea, 
that  state  where  breathing  is  possible  only  in  an  erect 
posture,  and  under  violent  exertion  of  the  whole  body. 

One  easily  recognized  mode  of  breathing  may  be  particu- 
larly mentioned,  the  so-called  Cheyne-Stokes'  sham  breath- 
ing, which  always  denotes  grave  disorder.  Here  longer 
or. shorter  intervals  occur  between  respiration;  breathing 
stops,  begins  again  almost  imperceptibly,  and  increases  in 
strength,  sometimes  becoming  very  labored  and  panting ; 
then  again  it  grows  weaker,  until  another  interval  takes 
place.  Late  researches  show  that  this  mode  of  breathing 
is  not  always,  as  was  formerly  believed,  a  certain  symptom 
of  approaching  death ;  but,  when  occurring  in  adults,  it  is 
always  a  symptom  very  unfavorable. 

16.  Expectoration  streaked  with  blood  is  always  suspi- 
cious ;  if  it  continues  for  any  length  of  time,  or  becomes 
frequent,  it  is  indicative  of  serious  disturbance.  Hemor- 
rhage is  always  a  symptom  of  a  lesion  threatening  life,  and 
may  occasion  speedy  death. 

When  the  matter  discharged  by  expectoration  is 
abundant,  diffluent,  or  consists  chiefly  of  pus,  it  denotes  an 
extensive  chronic  disorder,  and  wears  away  the  strength. 

1 7.  Frequent  hiccoughing,  deep  sighing,  and  yawning, 
in  acute  diseases,  are  unfavorable. 

18.  Flatulent  distention  of  the  abdomen,  tympanites 
(a  swelling  of  the  abdomen  caused  by  accumulation  of  air 
in  the  intestinal  tube  or  in  the  peritoneum),  meteorism  (dis- 
tention of  the  abdomen  with  wind),  during  a  disease,  always 
indicate  extreme  danger.  If  these  symptoms  increase  to 
a  high  degree,  they  threaten  a  speedily  fatal  termination. 

19.  Frequent  and  persistent  vomiting  portends  the 
existence  of  deep  disorder  (cholera,  cancer  of  the  stomacb). 


DANGEROUS    TO   LIFE.  193 

During  diseases  of  the  brain  and  of  the  peritoneum,  a  less 
frequent,  even  a  single,  vomiting  is  indicative  of  serious 
disease  of  these  important  organs.  Discharges  of  feculent 
matter  upward  show  that  the  bowel  has  become  strangled, 
and  that  its  contents  cannot  pass  through.  Vomiting  of 
blood  occurs  only  in  serious  lesions  of  the  stomach  (ulcera- 
tion, cancer,  of  the  stomach).  Vomiting  of  pus  is  indica- 
tive of  the  breaking  of  an  abscess  in  the  neighborhood 
of  the  stomach  or  oesophagus,  and  is  always  a  serious 
symptom. 

20.  Very  frequent  evacuations  of  liquid  stools  during 
chronic  diseases,  especially  phthisis,  are  very  unfavorable, 
and  lead  soon  to  exhaustion  and  death.  Of  the  acute 
affections  of  diarrhoea,  cholera,  and  dysentery,  it  should 
be  said,  if  the  discharges  occur  frequently,  and  if  in 
dysentery  the  stools  are  bloody,  the  attack  is  serious  and 
dangerous,  especially  at  times  when  these  epidemics  are 
prevalent. 

21.  Retention  of  urine,  dysuria  (inability  to  pass  the 
urine),  becomes  always  serious  and  dangerous  if  it  is 
protracted,  particularly  in  aged  persons. 

22.  Profuse  bleedings  of  any  kind  are  always  serious. 
Danger  of  bleeding  to  death  is  present,  when  the  face  be- 
comes pale  and  covered  with  cold  sweats  ;  if  nausea,  cloudi- 
ness before  the  eyes^  or  ringing  in  the  ears,  occurs  ;  if  the 
pulse  becomes  low,  or  weak,  or  disappears  ;  if  there  are 
convulsions  of  particular  limbs  :  if  the  eyes  turn  upward. 

All  these  symptoms  tend  to  show  the  existence  of  such 
disturbance  in  the  organism  as  to  threaten  life.  Some  of 
them,  of  course,  are  more,  others  less,  important.  The 
coexistence  of  more  than  one  of  them  renders  the  proba- 
bility of  fatal  termination  greater.  Moreover,  the  same 
symptoms  may  be  more  unfavorable  in  one  disease  than  in 


194  SIGNS   OF   DISEASES   DANGEROUS  TO    LIFE. 

another.  To  enter  into  any  minute  details  hereon  is  neither 
possible  nor  necessary.  I  hope  that  the  enumeration  given 
will  be  sufficient  to  assist  the  priest,  by  the  aid  of  his  own 
observation,  in  detecting  the  presence  of  such  diseases  as 
are  dangerous  to  life.  It  is  certain  that  there  are  some 
critical  conditions  which  are  not  discernible  to  unprofes- 
sional persons,  nor  can  be  made  so. 

In  these  cases,  as  well  as  in  those  of  sudden  danger, 
and  in  those  wherein  the  priest  has  been  called  very  late, 
it  is  necessary  for  him  to  be  acquainted  with  the  symptoms 
of  approaching,  and  especially  of  immediately  imminent, 
death.  Many  symptoms,  a  high  degree  of  which  indicates 
death  as  imminent,  have  already  been  mentioned  in  the 
above  list.  A  combination  of  these  symptoms,  varying 
according  to  the  disease,  gives  us  a  picture  of  the  death- 
agony. 


G  — THE  AGOIST. 

Gradually  the  decline  of  the  whole  organism  progresses. 
Through  paralysis  of  the  muscles  the  lineaments  of  the 
face  relax ;  the  whole  face  becomes  drooping,  as  it  were  ; 
the  lower  jaw  sinks,  makirig  the  face  appear  longer ;  the 
eyelids  droop  without  closing,  however ;  the  nose  and  the 
temples  shrink  ;  every  feature  seems  more  sharp  and  pointed 
in  consequence  of  the  bones  becoming  prominent  through 
the  flaccid  soft  parts ;  the  eyes  become  fixed  ;  the  cornea 
becomes  dim,  glassy,  without  lustre,  and  hollow  ;  the  mouth 
is  half-open  ;  the  lips  dry,  thin,  and  apart  *,  the  whole  face 
assumes  a  dusky  grey-yellow,  sometimes  a  bluish,  hue  j 
the  ears,  nose,  and  successively  the  whole  face,  become 
cold,  and  generally  covered  with  a  cold,  clammy  perspira- 
tion. Every  motion  of  the  extremities  seems  suspended, 
or  else  is  manifested  only  in  jerking  attempts  at  motion. 
There  is  a  tendency  of  the  body  to  sink  toward  the  bottom 
of  the  bed  ;  the  head  is  drawn  backward  or  aside  ;  limbs 
raised  fall  back  powerless.  The  breathing  is  labored  and 
slow,  next  irregular  and  unequal,  sighing,  stertorous,  and 
croaking.  Involuntary  evacuations  take  place  in  conse- 
quence of  paralysis  of  the  sphincter-muscles.  Often  the 
larynx  is  paralyzed,  and  drinks  fall  through,  as  it  were, 
and  reach  the  stomach  with  a  rumbling  noise.  The  pulse 
grows  weak,  erratic,  intermittent,  and  in  the  end  stops 
entirely. 

Coldness  of  the  limbs  extends  upward,  and  unconscious- 
ness supervenes  J  the  senses  of  smell,  taste,  and   touch. 


196  THE    AGONY. 

become  first  extinct,  then  that  of  vision.  Hearing  generally 
remains  to  the  last,  and  it  sometimes  manifests  itself  even 
after  all  the  other  senses  have  become  entirely  extinct. 
Persons  in  a  trance  are  not  unfrequently  found  possessed 
of  the  sense  of  hearing. 

The  entire  skin  becomes  pale  and  withered.  In  chronic 
diseases,  there  is  often  a  sudden  disappearance  of  edema- 
tous swellings,  and  a  drying-up  of  the  surface  of  old  ulcers. 

After  paralysis  has  attacked,  in  a  more  or  less  complete 
manner,  all  parts  of  the  organism,  the  scene  is  generally 
ended  with  one  or  more  deep  inspirations,  separated  by 
longer  intervals,  and  followed  by  a  slow,  long-drawn 
expiration. 

•  The  agony  is  also  called  the  mortal  struggle.  Unpro- 
fessional persons  may  take  such  a  view  of  it.  But  in  the 
majority  of  cases  the  event  of  death  is  not  at  all  violent, 
even  if  we  set  aside  the  easy  death  of  people  dying 
apparently  of  old  age,  which  resembles  almost  a  falling 
asleep.  It  is  of  no  rare  occurrence  that  patients  experi- 
ence in  painful  diseases  an  almost  comfortable  condition 
shortly  before  death.  This  results  from  nothing  else  than 
the  progress  of  paralysis,  by  which  the  tormented  organism 
is  quietly  dissolved,  as  the  senses  are  dulled  under  its 
influence.  Neither  the  manner  of  death,  nor  the  duration 
of  the  agony,  can  be  foretold  with  any  approach  to  certainty 
from  the  circumstances,  whether  of  the  disease  itself,  or  of 
the  patient's  strength,  in  acute  diseases.  It  often  happens 
that  a  strong  person  dies,  after  an  acute  disease,  easily, 
and  in  a  short  agony ;  whilst  an  exhausted  and  emaciated 
patient,  dying  of  tubercular  consumption,  presents  the 
complete  picture  of  agony  for  days,  and  expires  only 
slowly  and  with  difficulty,  under  stertorous  breathing  that 
is  in  a  high  degree  alarming  to  those  around  him. 


THE    AGOXY.  197 

After  tkc  last  respiration  the  person  is  considered  dead, 
although  perhaps  sometimes  minutes  elapse  before  the 
vital  spark  becomes  completely  extinct.  The  muscles  of 
the  heart  and  of  the  arteries  make,  often,  after  the  last 
respiration,  some,  although  feeble,  movements.  If  the 
agony  and  the  gradual  fading-away  have  been  observed, 
we  may  be  convinced  of  death  some  minutes  after  the  last 
respiration.  However,  there  are  some  forms  of  death 
wherein  doubts  may  be  entertained  whether  death  has 
really  taken  place.  Hence  it  will  not  be  amiss  to  offer  a 
few  remarks  on  trance,  and  on  the  signs  of  death,  and  on 
the  value  to  be  attached  to  them. 


H— CASES  OF  APPAKENT  DEATH.   • 

Apparent  death,  or  trance,  is  that  condition  of  the  body 
wherein,  although  no  signs  of  life  are  noticeable,  yet 
probable  or  unmistakable  signs  of  death  may  not  show 
themselves.  The  functions  of  respiration  and  circulation 
seem  to  he  extinct.  There  is  no  expansion  of  the  chest  or 
nostrils  indicating  respiratory  movements  ;  a  looking-glass 
held  before  the  nose  and  mouth  sometimes  does  not  receive 
any  impression  j  even  a  feather  oftentimes  shows  no  move- 
ment. Pulse  and  contraction  of  the  heart  are  entirely 
lost,  or  nearly  so  j  the  face  and  the  mucous  membranes  are 
pale  and  without  blood,  as  is  also  the  whole  skin. 

Redness,  or  rising  of  blisters,  produced  by  application 
of  compresses  with  boiling  water,  or  vinegar,  or  mustard- 
plasters,  frictions,  and  chafing,  is  a  sure  symptom  that 
the  body  is  not  in  reality,  but  only  apparently,  inanimate. 
The  absence,  on  the  other  hand,  of  these  symptoms  is  no 
certain  proof  of  death,  as  some  cases  of  apparent  death 
have  come  under  observation  wherein  reddening  of  the 
surface  and  rising  of  blisters  did  not  appear,  yet  resusci- 
tation followed  afterward.  The  same  may  be  said,  if  drops 
of  blood  ooze,  for  instance,  from  the  lips  or  tongue  after 
the  insertion  of  a  needle.  Their  appearance  is  a  sure  sign 
of  trance  ;  their  absence,  no  conclusive  proof  of  death. 

All  motion  ceases^  the  limbs  either  fall  heavily  if  raised,  or 
become  stiiF,  and  retain  any  position  which  may  be  given 
them.      The  eyelids  do  not  close,  if  they  are  opened,  or 


CASES   OF  APPARENT  DEATH.  199 

if  the  eyeball  is  touched,  because  the  patient  is  insensible 
to  everything,  or  at  least  no  sensation  shows  itself.  The 
senses  of  sight,  smell,  taste,  and  also  of  hearing,  seem  to 
be  lost.  But  it  should  be  remembered  that  the  sense  of 
hearing  may  not  be  affected,  even  though  all  other  signs 
of  life  be  absent.  Caution  must  therefore  be  used  with 
regard  to  expressions  and  words  in  presence  of  persons 
apparently  dead.  There  is  apparent  loss  of  consciousness, 
but  it  is  apparent  only,  as  has  been  the  case  in  some  well- 
proved  occurrences  of  this  kind. 

The  body  may  be  warm^  if  the  apparent  death  ensued 
suddenly,  but  the  temperature  of  the  body  may  also  be  very 
low,  and  may  give  way  to  the  complete  coldness  of  death ; 
for  instance,  in  cholera,  and  in  persons  drowned  or  frozen. 

Cases  of  trance  may  occur  after  all  spasmodic  diseases, 
such  as  tetanus,  epilepsy,  eclampsia,  catalepsy,  convulsions 
of  infants,  spasmodic  asthma,  etc.  f  after  great  loss  of 
blood;  exhaustion  from  long  abstinence  or  great  fatigue, 
for  instance,  after  long,  weary  marches,  or  after  difficult 
labors  ;   or  after  freezing. 

Trance  may  be  the  consequence  of  injury  to  the  brain 
from  blows,  falls,  pressure  of  air  (explosions) ;  from  light- 
ning, sunstroke,  apoplexy.  Again,  it  may  take  place  after 
suffocation  from  irrespirable  gases  (carbonic  acid,  hydrogen 
gas,  coal-gas) ;  after  choking,  hanging,  or  drowning ;  or 
through  the  presence  of  foreign  matters  in  the  throat,  or 
in  the  cavity  of  the  mouth ;  also  in  the  case  of  new-born 
infants. 

Finally,  it  may  occur  after  poisonings ;  especially  after 
narcotic  poisons,  as  chloroform,  opium,  morphia,  prussic 
acid,  etc. 

From  this  enumeration  of  the  principal  causes  of  trance, 
it  is  clear  that  the  danger  of  being  buried  alive  is,  after  all, 


'200  CASES  OF  APPARENT  DEATH. 

not  so  very  great  as  many  represent  it,  among-st  whom 
are  some  writers  on  pastoral  medicine.  The  causes  I  have 
enumerated  are  of  rare  occurrence.  Besides^  they  attract 
the  attention  of  unprofessional  and  professional  persons 
more  than  the  common  diseases  and  modes  of  death,  on 
account  of  their  strangeness.  There  may  have  been  cases 
in  which  people  have  been  buried  alive,  whilst  in  a  state 
of  apparent  death ;  and,  in  some  instances,  they  have 
awakened  afterward.  Certainly  this  is  a  horrible  possibility 
to  contemplate.  But  the  number  of  casualties  of  the  kind 
has  been  greatly  exaggerated  by  sensational  newspapers. 
The  way  to  avoid  such  lamentable  mistakes  is  easy.  In 
doubtful  cases  the  supposed  corpse  should  not  be  buried 
till  unequivocal  signs  of  death  liave  supervened.  If  any 
certain  signs  of  death  be  wanting,  the  proper  means  of 
resuscitation  should  be  made  use  of.     (See  farther  on.) 


J —SIGNS  OF  DEATH. 

Unequivocal  signs  of  death  are,  "  cadaveric  rigidity  and 
putrefaction^^ 

In  cadaveric  rigidity  (rigor  mortis)  the  muscles  are 
firmly  contracted.  They  are  tense  and  hard  to  the  touch, 
and  shortened ;  the  flexor  muscles  overbalance  the  exten- 
sor muscles,  so  that  the  limbs  are  bent,  and  the  thumbs 
are  drawn  a  little  into  the  palms  of  the  hand.  The  lower 
jaw  is  again  drawn  up,  and  the  mouth  firmly  closed.  If 
the  rigidly  bent  limbs  are  stretched  by  force,  the  muscles 
do  not  contract  again,  but  remain  relaxed.  This  constitutes 
the  difference  between  the  contraction  during  cadaveric 
rigidity,  and  the  spasmodic  contraction  of  the  living  muscle. 
Rigidity  appears  in  nearly  all  corpses  ;  it  is  not  developed 
perhaps  in  premature  foetuses,  nor  in  frozen  and  thawed 
bodies.  It  appears  one  to  twenty-four  hours  after  death, 
and  continues  from  six  to  forty-eight  hours.  Sometimes 
it  continues  only  for  a  brief  period,  so  that  it  may  escape 
observation.  The  absence  of  rigidity  therefore  is  no  proof 
of  trance,  because  it  may  have  disappeared  already,  or 
it  may  not  yet  have  been  developed.  The  presence  of 
rigidity  is  an  unequivocal  sign  of  death. 

The  process  of  putrefaction  commences  as  soon  as 
the  rigidity  disappears.  It  is  manifested  by  a  peculiar 
fetor  of  the  corpse,  by  the  greenish  coloring  of  the  skin, 
especially  on  the  walls  of  the  abdomen  and  on  the  spaces 
between  the   ribs  j  by  the  development  of  gases  in  the 


202  SIGNS   OF  DEATH. 

intestines,  with  flatulent  distention  of  the  abdomen,  and, 
later  on,  of  the  whole  corpse ;  by  blisters  and  elevations 
of  the  skin  filled  with  a  fluid  of  dirty-greenish  color,  or 
with  gases,  and  by  a  putrid  oozing  from  the  mouth.  The 
anus  stands  open. 

The  process  of  putrefaction  is  accelerated  by  heat  and 
moisture.  This  circumstance  may  be  used  to  prove 
death.  If  there  is,  for  instance,  suspicion  of  death,  and 
all  means  of  resuscitation  have  been  tried  in  vain,  and  if 
unequivocal  signs  of  death  are  still  wanting,  the  best  way 
is  to  carry  the  corpse  into  a  room  heated  from  18°  to  20'-* 
R.,  wherein  the  air  is  kept  moist  by  means  of  suspended 
wet  cloths,  or  by  water  put  in  large  flat  dishes.  If  it 
be  a  case  of  apparent  death  only,  no  harm  will  arise  from 
the  procedure  j  otherwise  the  symptoms  of  putrefaction  will 
soon  appear. 

Fretty  sure  signs  of  death  are :  cadaveric  spots,  and  the 
broken  eye.  The  cadaveric  spots  are  of  a  dark  blue  and 
purple  color,  and  appear  from  eight  to  fifteen  hours  after 
death,  sometimes  sooner,  sometimes  later,  on  the  oblique 
parts  of  the  body ;  that  is,  on  that  side  whereon  the  body 
rests.  Usually  confined  to  the  back  and  pelvis,  because 
corpses  generally  lie  on  the  back,  they  are  also  found  on 
the  face,  chest,  and  abdomen,  when  the  body  has  been 
lying  on  the  face.  They  are  not  absolutely  sure  signs  of 
death,  because  they  have  been  observed  even  during  life, 
and  also  on  persons  who  have  been  resuscitated  from  appar- 
ent death.  Especially  after  sufi'ocation  from  coal-gas,  they 
are  found  when  life  still  exists.  In  this  case,  they  are 
present,  not  only  on  the  oblique  parts  of  the  body,  but 
they  are  distributed  over  the  surface  of  the  body  inde- 
pendently of  its  position.  Their  absence  is  no  conclusive 
sign  of  llfej  because  they  may  not  yet  have  appeared,  or 


SIGNS   OF  DEATH,  203 

may  not  develop  at  all,  as  is  the  case  in  corpses  which 
are  either  very  empty  of  blood,  or  very  dropsical.  The 
presence  of  the  cadaveric  spots  is,  however,  a  pretty  sure 
indication  of  death. 

The  hroJcen  eye.  A  few  hours  after  death  the  conse- 
quences of  evaporation  are  manifested  in  the  eye.  The 
tension  of  the  eyeball  relaxes ;  the  sclerotica  (white  of  the 
eye)  assumes  a  yellow  hue ;  a  little  later  it  becomes  dry 
and  attenuated,  so  that  the  choroid  shines  through  with 
a  bluish  color,  and  causes  irregular  blue  spots  to  appear 
on  the  sclerotica.  The  cornea  loses  its  lustre,  partly  by 
evaporation,  partly  by  the  separation  of  the  epithelium, 
and  becomes  dim  and  granulous, — dusty,  as  it  were.  But 
the  broken  eye  is  not  an  unequivocal  sign  of  death.  The 
dimness  of  the  cornea  is  sometimes  observed  during,  and 
even  before,  the  agony.  Also  the  attenuation  of  the 
sclerotica  may  occur  during  life.  After  some  modes  of 
death,  however,  the  eye  of  the  corpse  remains  for  some 
time  firm,  tense,  and  shining;  for  instance,  from  sudden 
death  from  apoplexy,  from  suffocation,  from  chloroform, 
prussic  acid,  alcohol. 

One  sign  of  death,  which  is  regarded  by  some  as  a 
quite  sure  one,  may  be  mentioned  here,  although  it  is 
seldom  that  a  priest  will  be  able  to  apply  the  test.  The 
pupil  of  the  eye,  after  real  death,  soon  loses  its  irritability, 
and  neither  contracts  nor  dilates  any  more.  A  living,  not 
paralyzed,  pupil  contracts  immediately  under  the  influence 
of  stronger  light.  On  a  corpse,  even  rays  of  light  that 
have  been  concentrated  by  a  convex  lens  have  no  such 
effect  any  more.  A  perceptible  dilatation  of  the  living 
pupil  may  be  caused  in  a  short  time  ( 10-15  minutes ),  by 
the  instillation  of  a  solution  of  atropine  into  the  eye.  The 
atropine  ha«  absolutely  no  effect  on  the  eye  of  a  corpse 


204  SIGNS  OF  DEATH.: 

one  to  two  hours  after  death.  Bouchut  *  calls  atropine  the 
"  reactif  de  la  mort, ''  He  says  that  he  effected  a  clearly 
perceptible  dilatation  of  the  pupil  of  patients  in  very  deep 
coma  by  a  solution  of  atropine  (0.1  gramme  to  30.0  grammes 
of  water).  If  such  a  solution  is  at  hand,  and  a  competent 
person  t  (a  druggist  in  the  absence  of  a  physician)  present 
to  employ  it,  the  first  thing  to  be  done  is  to  compare 
both  pupils,  whether  they  are  of  the  same  dimension.  If 
this  is  the  case,  the  solution  is  instilled  into  one  eye  ; 
after  a  while  the  comparison  with  the  other  not  atropined 
eye  will  show  whether  a  dilatation  has  taken  place  or  not. 
Until  further  observations  are  made,  I  regard  this  '^reactif 
de  la  mort "  only  as  a  pretty  sure  means  of  proving  death. 

The  foregoing  observations  are  equally  applicable  to  the 
test  of  the  contractibility  of  the  muscles  by  electric  cur- 
rents ;  I  prefer  it,  however,  to  the  atropine  test.  It  can 
seldom  be  employed,  because  it  is  not  often  that  an  electric 
apparatus  is  at  hand.  This  is  a  great  pity,  for  electricity 
may  also  be  of  great  service  as  a  means  of  restoring  life. 
The  excitability  of  the  muscles  declines  soon  after  death, 
and  becomes  extinct  about  three  hours  after  death  has 
taken  place.  A  reaction  of  the  muscles,  therefore,  to 
electric  currents  would  be  an  indication  of  trance,  or  would 
at  least  show  that  death  is  quite  recent.  The  absolute 
absence  of  any  reaction  to  strong  electric  currents  may  be 
regarded  as  a  pretty  sure  sign  of  death. 

There  are  other  signs  of  death,  but  they  cannot  be  as 
much  relied  upon.  Coldness,  for  instance,  may  be  present 
even  in  cases  of  apparent  death :  for  instance,  in  drowned 
or  frozen  persons  ;  also  in  those  suffering  from  cholera,  in 

*  Quoted  after  Dr.  J.  Gayat,  ^'Sur  les  s'lgnes  oculaires  de  la  mort,"  in  the 
"Archives  generales  de  medecine,"  May,  1876;  pag.  531  ff. 
t  Atropine  is  a  very  dangerous  poison. 


SIGJsS    OF   DEATH.  205 

that  stage  of  this  disease  called  asphyxia.  Absence  of  all 
the  functions  of  life  is  also  a  sign  of  death.  Yet  death  is 
rendered  probable  only  by  the  presence  of  the  pretty  sure 
signs ;  its  absolute  certainty  can  be  concluded  only  from 
absolutely  certain  signs.  The  unequivocal  signs  render 
the  probability  of  death  the  greater,  the  more  of  them  are 
found  together. 


K  — WHAT  IS  TO  BE  MM  IN  OASES  OP 
DANGER  OF  SUDDEN  DEATH,  MISHAPS,  AND 
ACCIDENTS  OP  A  SEEIOTJS  NAIUEE. 

Cases  of  trance,  some  morbid  affections  of  various 
cbaracter,  poisonings  by  organic  and  inorganic  poisons, 
demand  as  prompt  attention  as  possible,  because,  other- 
wise, they  may  rapidly  lead  to  death.  Immediate  recourse 
to  the  physician  is  sometimes  impracticable,  especially  in 
the  country.  The  priest,  however,  is  generally  summoned 
immediately ;  and  he  is,  often,  the  only  one  among  those 
present  who  is  possessed  of  knowledge  and  judgment 
enough  to  render  him  capable  of  pointing  out  and  direct- 
ing the  necessary  help  under  these  difficult  circumstances. 
For  this  reason  I  thought  it  of  great  importance  to  give  here, 
at  least,  a  general  outline  of  what  should  first  be  done  in 
cases  of  the  kind.  Abstaining  from  all  physiological,  patho- 
logical, and  therapeutical  explanations,  I  make  only  such 
suggestions  as  come  within  the  reach  of  those  outside  the 
profession.* 

*It,  woald  be  a  verj  useful  an-angement,  especially  in  localities  where 
there  is  no  resident  physician,  if  a  supply  of  instruments,  bandages,  and 
medicines,  were  always  kept  on  hand  for  use  in  cases  of  emergency.  But 
as  this  will  probably  remain  a  desideratum,  where  the  commonwealth  or 
corporations  do  not  take  the  matter  in  hand,  I  suggest  only  such  means  as 
can  be  used  in  the  absence  of  such  a  supply.  I  refrain  likewise  from  all 
directions  as  to  what  should  be  contained  in  such  a  supply  oi  bandages  and 
medicines. 


MEANS   OF  RESTORING  LIFE.  207 

L— RULES  FOR  RESTORING  LIFE  IN  CASES  OP 
APPARENT  DEATH. 

Help  in  such  cases  must  be  prompt  and  energetic,  but 
not  rash  and  inconsiderate. 

The  first  thing  to  be  done  is  to  remove  everything  that 
presses  on  the  body,  or  on  parts  of  it :  such  as  neckties 
(rope  around  the  neck),  suspenders,  coat-bindings,  boaices, 
beks,  closely- tied  garters.  Total  undressing  is  generally 
not  immediately  necessary,  except  in  cases  of  drowning  or 
freezing. 

Nose,  mouth,  throat,  and  larynx  should  then  be  cleansed 
as  much  as  possible  from  mucus,  sand,  and  all  foreign 
matters,  either  with  the  fingers^  or  by  means  of  sponges, 
feathers,  camel  hair  pencils,  or  wood-splinters  wrapped  with 
linen.  The  practice  of  resuscitation  by  setting  the  drowned 
person  on  the  crown  of  his  head  is  nonsensical  and  fraught 
with  danger.  The  body  of  the  patient  may,  perhaps,  be  laid 
on  its  side  for  some  seconds  with  the  upper  parts  a  littl/e 
inclined.  Water  that  has  been  swallowed  will  not  escape 
by  this  method,  nor  by  the  plan  above  denounced ;  but 
water  that  has  only  entered  the  throat  and  larynx  will 
escape  after  only  a  slight  inclination  of  the  body. 

The  patient  should  be  carried  to  a  proper  place :  in 
summer,  into  the  fresh  air;  in  winter,  into  a  moderately 
warmed  apartment.  (Frozen  people  must  be  carried  into 
cold  rooms  :  see  farther  on.)  The  patient  should  be  placed 
on  a  bed,  mattress,  straw-ticking,  or  straw,  with  the  head 
and  shoulders  raised,  so  that  there  may  be  free  access  to 
the  body  from  all  sides,  and  that  those  assisting  niay  not 
be  hindered.  No  more  should  be  admitted  into  the  room, 
or  into  any  adjoining  one,  than  are  necessary  :  four,  at 
most  six,  persons  will  do. 

The  me^ns  for  reanimation  are  t— 


208  MEANS   OF   RESTORIXG   LIFE. 

1. — Irritants. 

For  tlie  nerves  of  the  shin : — The  chest,  arras  and  legs, 
hands  and  feet,  may  be  rubbed  and  chafed,  either  with 
the  hand,  or  with  woollen  cloths,  fur,  flax,  straw,  brushes. 
The  temples  and  the  forehead,  the  chest  and  the  pit  of 
the  heart,  should  be  washed  with  warm  water,  vinegar, 
brandy.  Cold  water  may  be  sprinkled  on  the  face  and 
chest ;  affusion  of  a  thin  stream  of  cold  water  from  a  height 
of  four  to  five  feet  on  the  head  and  dow.n  the  spine.  Hot 
water  or  sealing-wax  maybe  dropped  on  the  pit  of  the  heart; 
mustard  plasters,  or  blotting-paper  with  sinapine,  should 
be  applied  to  the  pit  of  the  stomach,  calves  of  the  legs,  or 
the  soles  of  the  feet  5  dry  cupping-glasses  on  the  neck, 
thighs,  back. 

For  the  nasal  nerves  : — Some  strong  odor  should  be  ap- 
plied to  the  nostrils,  such  as  hartshorn,  eau  de  cologne, 
onions,  horseradish,  burnt  feathers,  or  snuff;  sneezing- 
powder,  pepper,  vinegar,  may  be  put  into  the  nostrils.  Or 
the  nose  can  be  tickled  with  a  feather,  fine  straws,  or 
horsehairs. 

For  the  throat: — The  tonsils  and  the  throat  may  be 
tickled  either  with  the  finger,  or  with  a  quill,  hair-pencil, 
or  a  splinter  wrapped  with  linen. 

Also  the  rectum  may  be  irritated  by  clysters  of  ice,  or 
warm  soap-suds  or  vinegar,  or  honey  and  water,  salt- 
water, or  tobacco-decoctions  (fifteen  to  twenty  grammes,  to 
^ve  hundred  grammes  water),  etc. 

2. — Means  to  Bestore  the  Heat  of  the  Body, 

Besides  the  rubbing  and  brushing  of  the  body,  the  bed 
may  be  warmed  with  bottles  of  hot  water  (they  must  not 


MEANS   OF  RESTORING   LIFE.  209 

be  filled  full,  lest  the  corks  should  fly  off),  hot  stones,  or 
warming-pans  ;  wrapping  up  the  patient  in  hot  blankets  or 
cloths,  covering  him  with  hot  ashes  or  hot  sand.  Where 
hot  water  can  be  had,  a  warm  bath  (30-32°  R.)  is  one  of 
the  best  means  of  communicating  heat. 

3. — Artificial  Breathing. 

This  is  the  most  important  of  all.  Artificial  respiration 
may  recall  the  latent  principle  of  life,  and  is  therefore  to 
be  performed  as  soon  as  possible,  together  with  the  other 
aids,  as  warming  and  the  use  of  irritants. 

The  mode  of  inflating  the  lungs  through  the  mouth  and 
nose  of  the  patient,  be  it  either  from  mouth  to  mouth  or 
by  bellows,  is  good  for  nothing,  although  still  recom- 
mended. Even  if  the  tongue  is  drawn  forward  and  the 
larynx  pressed  back,  the  air  will  sooner  pass  into  the 
stomach  than  into  the  lungs.  A  much  better  mode  is 
either  to  compress  and  relax  alternately  the  chest  in  front 
and  from  the  sides ;  or  to  roll  the  patient  from  the  belly  to 
the  side  and  vice  versa^  placing  the  arm  of  that  side  on 
which  the  body  is  to  be  rolled  under  the  forehead.  An- 
other mode  of  effecting  respiration  is  an  alternate,  slow- 
and  steady  raising  of  the  arms  above  the  head,  and  lower* 
ing  and  pressing  the  same  to  the  sides.  These  movements 
should  be  made  ten,  twelve,  to  fifteen  times  a  minute,  in  a 
quiet  and  symmetrical  way. 

These  eff'orts  of  resuscitation  should  be  steadfastly  con- 
tinued from  four  to  six  hours.    Encoura^rinf)^  sio:ns  are  :  red- 
es   o     o 

dening,  especially  of  the  lips  and  cheeks  ;  warmth  of  the 
skin  ;  contraction  and  diminution  of  the  pupils  after  irrita- 
tion by  light  f  twitchings  of  the  angles  of  the  mouth,  and 
of  the  fingers  j  slight  tremors  of  the  lower  jaw,  and  of  the 


210  MEANS   OF   RESTORING   LIFE, 

eyes ;  retching,  sneezing,  sobbing,  sighing ;  a  rumbling  noise 
in  the  bowels  ;  separate  motions  of  respiration;  a  noticeable 
fluttering  of  the  heart  j  returning  pulse.  If  one  or  more 
of  these  signs  of  revival  appear,  the  efforts  should  be 
steadily  kept  up,  and  especially  those  to  produce  respiration, 
until  breathing  and  circulation  and  consciousness  have 
been  restored. 

So  soon  as  the  patient  can  swallow,  a  small  quantity  of 
warm  coffee,  tea,  or  a  little  wine,  or  brandy  and  water, 
should  be  given  him.  Generally  he  then  falls  asleep. 
The  sleep  must  not  be  disturbed,  but  the  breathing  and 
circulation  should  be  meanwhile  carefully  watched. 

If  all  efforts  should  prove  unsuccessful,  if  no  indications 
of  returning  life  appear,  the  corpse  may  be  covered  ;  but 
it  must  be  watched  for  the  next  twenty-four  hours. 

The  bodies  of  frozen  people  require  a  somewhat  differ- 
ent treatment.  In  removing  the  body  great  precaution 
must  be  observed,  because  the  stiffly  frozen  limbs,  and 
especially  the  smaller  members,  such  as  ears,  nose,  fingers, 
and  toes,  may  be  easily  hurt,  or  even  broken  off.  The 
body  should  be  carried  to  a  cold  place  where  there  is  no 
draught  of  air.  The  articles  of  clothing  are  to  be  cut  off 
as  well  as  they  can  be  with  a  pair  of  scissors.  Then  the 
whole  body,  except  only  the  mouth  and  nose,  must  be 
covered  with  snow,  or  blankets  soaked  with  ice-cold  water, 
or  be  placed  into  an  ice-cold  bath.  If  the  process  of  thaw- 
ing has  progresssed  so  far  that  the  limbs  may  be  bent,  the 
skin  should  be  rubbed  with  snow  or  wet  cold  cloths.  After 
this,  a  cold  clyster  may  be  thrown  into  the  bowels,  and 
artificial  respiration  commenced.  When  the  first  indica- 
tions of  returning  life  appear,  the  body  should  be  well 
dried,  and  rubbed  with  dry,  and  only  moderately  warm, 
cloths,  and  then  be  placed  iu  a  moderately  warm  bed,  in 


FIRST  HELP  IN   SUDDEN   ATTACKS.  211 

a  cold  room.  Besides  the  means  to  induce  respiration,  the 
before-named  irritants,  and  also  tepid  clysters,  and  tepid 
hand-  and  foot-baths,  may  be  applied. 

Single  frozen  parts,  as  hands,  feet,  fingers,  which  have 
become  white,  stiff,  and  insensible,  must  be  treated  in  the 
same  manner.  They  are  first  covered  with  snow,  then 
rubbed  with  cold  wet  cloths,  and  only  after  this  rubbed 
warm  and  dry,  or  put  into  a  tepid  bath. 

If  suffocated,  hanged,  strangulated  persons,  and  also 
frozen  persons  after  thawing^  have  the  head  red,  the  face 
blue  or  red,  the  eyes  protruding  and  shining,  cold  appli- 
cations should  be  administered  on  the  head,  or  blood  should 
be  drawn,  if  a  professional  man  is  at  hand. 


II.— FIRST    HELP   AFTER   SOME   SUDDEN    AT- 
TACKS OF  ILLNESS. 

Epidemics,  such  as  cholera,  dysentery,  etc.,  which  are 
treated  at  length  under  this  head  by  some  writers,  I  omit 
purposely.  For  non-professional  help  is,  in  the  majority 
of  such  cases,  only  detrimental.  Likewise,  I  do  not  think 
it  necessary  to  treat  of  the  prophylactic  means  against 
epidemic  and  other  contagious  diseases.  Living  according 
to  the  requirements  of  reason  and  health,  avoiding  all 
unnecessary  communication  with  infected  persons  and 
their  houses,  tranquillity  of  mind  and  moral  courage,  are 
the  best  prophylactic  means.  Priests  and  physicians,  who 
cannot  avoid  contact  with  the  sick,  must,  during  such 
periods,  be  especially  careful  to  avoid  all  excesses  ^  they 
should  take  plenty  of  exercise  in  the  fresh  air,  and  change 
their  clothing  often ;  they  should  frequently  wash  the  face, 
hands,  and  mouth  j  and,  perhaps,  after  great  exertion,  take, 


212  FIRST   HELP   IN    SUDDEN    ATTACKS. 

from  time  to  time,  during  the  day,  a  draught  of  wine  or 
good  brandy.  Other  means,  which  are  sometimes  recom- 
mended, such  as  aromatic  masticatories,  and  drinks,  and 
the  like,  draw  too  much  attention  to  the  danger  of  con- 
tagion, and  in  this  way,  perhaps,  make  the  disposition  to 
infection  only  the  greater.  The  counsel  Vering  gives  to 
the  priest,  to  have  the  windows  and  doors  of  the  sick-room 
opened  for  some  time,  and  the  air  purified  by  fumigations 
before  entering,  I  can  only  approve  of  conditionally.  So 
far  as  not  only  the  priest,  but  also  the  patient  and  those 
about  him,  may  derive  benefit  from  it,  there  is  no  objec- 
tion to  it.  But  because  the  priest  may,  by  excessive  pre- 
caution, seem  over-anxious  about  his  own  safety  and  the 
possibility  of  infection,  which  might  exercise  a  depressing 
and,  indeed,  scandalizing  influence  upon  the  patient  him- 
self, and  those  around  him,  I  do  not  think  it  well  given. 
Both  should  be  avoided  by  the  priest.  If  he  follows  the 
advice,  he  should  direct  the  sanitary  measure  of  ventila- 
tion in  such  a  way  as  to  make  it  appear  important  and 
necessary,  more  for  the  health  of  the  patient  and  his  nurses 
than  for  his  own  safety. 

Sudden,  dangerous,  attacks  of  illness,  in  which  non-pro- 
fessional persons  can  render  first  aid  with  advantage,  are  : 

Fainting  or  syncope  :  a  sudden  diminution  or  suspension 
of  all  the  functions  of  life,  sometimes  almost  resembling 
death.  A  common  fainting-fit,  with  unconsciousness,  is 
in  general  distinguished  from  apparent  death,  only  by  the 
presence  of  the  action  of  the  heart  and  of  the  pulse.  The 
latter  often  cannot  be  felt.  The  efforts  to  promote  resuscita- 
tion, however,  are  generally  soon  successful.  The  clothes 
should  be  loosened,  and  fresh  air  admitted.  The  appli- 
cation of  simple  irritants  is  sufficient.  The  most  simple, 
and  generally  successful,  means  is  to  dash  or  sprinkle  cold 


FIRST   HELP   IN   SUDDEN   ATTACKS.  213 

water  vigorously  into  the  face  of  the  patient.  This  may  be 
very  well  done  with  the  raouthj  if  no  syringe  is  at  hand. 

Apoplectic  seizure,  apoplexy.  The  patient  should  not  be 
carried  far,  but  should  be  placed  in  a  comfortable  posture 
on  the  very  spot  of  seizure,  with  his  head  and  chest  ele- 
vated. The  next  object  should  be,  to  loosen  all  articles 
of  clothing  which  cause  pressure,  and  to  admit  fresh  air, 
even  should  it  be  cold.  Then  cold  applications  are  to  be 
administered  to  the  head — best,  of  ice  or  ice-water  ;  bottles 
of  hot  water  are  to  be  applied  to  the  feet,  mustard-plasters 
to  the  calves  of  the  legs,  cupping-glasses  to  the  neck  and 
thighs.  Also  a  stimulating  clyster  of  salt-water  or  soapsuds 
may  be  injected.  Bloodletting  should  not  be  resorted  to, 
if  an  experienced  person  is  not  present. 

Strangulated  hernia  is  always  a  dangerous  affection, 
and  requires  immediate  attention.  It  may  be  recognized, 
if  an  existing  hernial  tumor  feels  hard  and  tense,  and 
cannot  be  returned.  The  patient  has  no  stool,  and  there 
is  vomiting,  sometimes  even  of  faeces,  as  the  natural 
passage  is  obstructed.  An  attempt  should  be  made  to 
reduce  the  hernia.  For  this  end,  the  patient  is  laid  on 
his  back  in  an  entirely  horizontal  posture.  He  should 
draw  up  his  thighs.  Simple  pressure  on  the  hernia  from 
above  should  never  be  resorted  to.  The  swelling  should 
be  grasped  so  that  the  ends  of  the  fingers  span  that  part 
nearest  to  the  belly  (the  aperture),  and  slightly  squeeze 
it.  It  may  then  be  tried  to  return  the  rupture  by  pressing 
it  gently  toward  the  abdomen  ;  proceeding  slowly  with 
this  pressure  from  the  hernial  aperture  to  the  highest  part 
(neck)  of  the  sac.  If  the  contents  of  the  sac  become  soft, 
then  the  efforts  have  been  partly  successful  and  should  be 
continued.  The  reposition  is  successfully  accomplished, 
if  the  sac  of  the  hernia,  or  the  last  part  of  it,  suddenly 


214  FIRST  HELP   IN   SUDDEN  ATTACKS. 

glides  back,  generally  with  a  gurgling  sound.  No  violent 
pressure  and  squeezing  on  the  sac  should  be  used,  because 
this  may  make  it  mortify.  If  these  efforts  fail,  or  if  those 
present  do  not  like,  or  have  no  courage,  to  attempt  the 
reduction,  the  patient  should  at  least  be  placed  as  above 
described.  Then  warm,  softening  dressings  should  be 
applied,  of  flax-seed,  soaked  bread,  or  compresses  of 
hot  water ;  or  better,  perhaps,  cold  (ice)  and  warm  poul- 
tices may  be  alternately  put  on  the  rupture,  so  that  either 
of  these  is  kept  on  for  one  hour.  This  treatment  will 
occasionally  cause  the  return  of  a  rupture.  If  the  patient 
has  not  worn  a  truss  before,  it  must  be  procured  directly 
after  the  return  of  the  hernia. 

In  these  cases,  as  in  all  dangerous  aflfections,  a  medical 
man  should  always  be  sent  for  immediately,  before  the 
private  help  is  commenced. 

Epileptic  jits.  Sometimes  the  attack  is  sudden,  some- 
times its  approach  is  indicated  by  certain  premonitory 
signs.  The  patient  drops  down,  has  cramps  and  convulsions 
of  nearly  all  the  muscles,  contortions  of  the  eyes,  he  grinds 
his  teeth,  his  breathing  is  labored  and  often  stertorous,  he 
is  deprived  of  consciousness.  The  thumbs  are  drawn 
across  into  the  palms  of  the  hands,  the  mouth  ejects  a 
frothy  saliva,  the  forehead  is  often  covered  with  cold  per- 
spiration ;  in  short,  the  whole  attack  presents  an  alarming, 
and,  alas !  too  well-known,  spectacle.  The  prevalence  of 
these  fits  has  led  to  a  great  variety  of  treatment,  in  order 
to  shorten  or  to  stop  them.  Yvom  the  experience  I 
gathered  in  a  great  many  cases  of  epilepsy,  when  attached 
to  asylums  of  the  insane,  I  can  positively  state  that  all 
these  remedies  recommended  are  useless,  and  that  many, 
as,  for  instance,  the  favorite  breaking  of  the  clutched 
thumbs,  are  only  injurious.     Puring  an  attack  little  is  to 


FIRST   HELP    IN    SUDDEN   ATTACKS.  215 

be  done  in  the  way  of  treatment,  beyond  keeping  the  body 
of  the  patient  quiet,  with  the  head  raised,  keeping  him 
from  injuring  himself  in  his  often  violent  convulsions  and 
struggles,  removing  all  articles  of  clothing  which  cause 
pressure,  sending  away  all  useless  persons,  and  then 
patiently  waiting  till  the  attack  subsides.  If  there  should 
be  vehement  clenching  of  the  teeth  and  convulsion  of  the 
jaws,  it  will  be  a  safeguard,  for  the  protection  of  the 
tongue  and  the  teeth,  to  put  a  piece  of  wood,  cork,  leather, 
or  the  like,  between  the  teeth.  After  some  minutes, 
generally  less  than  a  quarter  of  an  hour,  and  often  after 
some  seconds,  the  patient  recovers  consciousness,  the 
cramps  subside,  the  breathing  becomes  deep  and  sighing, 
the  eyes  fixed  and  staring.  The  attacks  are  generally 
not  fatal,  unless  in  patients  who  have  suffered  very  frequent 
fits  for  a  long  period  of  time.  Such  persons  are  generally, 
nowadays,  confined  in  insane  asylums  and  similar  insti- 
tutions ;  consequently,  death  during  epileptic  fits  seldom 
occurs  outside  of  them.  Whether  an  attack  will  end 
fatally  or  not,  cannot  be  predicted.  Death,  when  it  occurs, 
is  caused  by  apoplexy  or  suffocation,  and  is  not  to  be 
looked  for  unless  the  attack  is  of  a  protracted  character. 

Spasmodic  affections  of  hysterical  persons  occasion  the 
summoning  of  the  priest  oftener  than  epileptic  fits.  I  have 
spoken  of  them  before,  and  I  have  only  to  repeat  here 
that  they  do  not  generally  end  fatally.  In  epileptic  fits  I 
counselled  absolute  non-interference ;  here,  I  recommend 
that  a  glass  of  cold  water  be  thrown,  with  some  force,  in 
the  face  of  the  patient.  As  consciousness  is  often  present, 
the  sudden  shock  will  almost  always  make  the  attack  of 
shorter  duration. 

Bleedings  from  inner  organs,  which  make  themselves 
noticeable  outwardly  : — 


216  FIRST  HELP  IN   SUDDEN  ATTACKS. 

(a)  Vomiting  of  blood.  When  blood  is  vomited  from  the 
stomachy  it  is  known  by  its  dark,  dirty  color,  and  by  being 
coagulated  and  mixed  with  the  other  contents  of  the 
stomach.  Even  if  liquid  florid  blood  is  vomited,  it  is  readily 
distinguished  from  hemorrhage  of  the  lungs  by  its  not  being 
frothy  :  it  is  shown  to  come  from  the  lungs  by  its  frothiness. 
Besides,  when  blood  is  vomited  from  the  stomach,  it  is 
usually  preceded  and  accompanied  by  weight,  pain,  and 
a  feeling  of  heat  in  the  region  of  the  stomach.  It  is  of  use, 
in  ascertaining  the  source  of  the  blood,  to  find  out  whether 
there  has  previously  existed  disease  of  the  stomach.  The 
patient's  clothes  should  be  loosened ;  cool  temperature,  rest 
of  body,  tranquillity  of  mind,  and  strict  diet,  are  necessary. 
Cold  liquids  (vinegar,  or  lemon-juice  in  water,  cold  water, 
ice-water),  but  in  small  quantities  only,  and  rarely,  may 
be  given ;  or,  if  possible,  the  patient  may  swallow  bits  of 
ice.  If  even  these  things  incite  the  stomach  to  new 
bleedings  and  vomitings,  then  only  external  applications 
should  be  used  :  cold  dressings,  ice  on  stomach  and  abdo- 
men ;  large  mustard-plasters  on  legs  and  arms  ;  hot  foot-  and 
hand-baths,  wherein  some  salt  or  ground  mustard  has  been 
thrown. 

Bleeding  from  the  intestine.  In  general,  the  same  rem- 
edies are  to  be  employed.  Also,  a  very  cold,  but  small, 
clyster  (6-8  tablespoonfuls)  will  often  be  efficient.  Bleed- 
ings from  hemorrhoids  must  be  checked,  if  they  last  too 
long,  or  if  too  much  blood  escapes  (more  than  10-12  table- 
spoonfuls).  Cold  clysters,  cold  compresses,  cold  hip-baths, 
bladders  filled  with  ice,  are  remedial. 

(b)  Bleeding  from  the  lungs.  The  blood  is  coughed  up, 
always  florid,  usually  frothy,  pure,  or  mixed  with  mucus 
and  pus.  The  patient  should  lie  absolutely  quiet,  with  the 
chest  raised,  and  should  be  prevented  from  talking.     Strict 


FIRST   HELP   IN    SUDDEN   ATIACKS.  217 

diet,  the  above-named  cooling  drinks,  dry  fine  salt  (every 
half-hour  a  teaspoonful),  dry  cupping  on  chest  and  back, 
mustard-plasters  on  thighs  and  calves,  hot  foot-baths  of 
ground  mustard,  and,  in  bad  cases,  cold  applications,  or  ice 
on  the  chest,  are  the  treatment. 

(c)  Bleeding  from  the  nose,  if  very  severe,  may  become 
dangerous  to  life.  It  is  generally  checked  by  the  person 
sitting  upright,  avoiding  coughing  and  blowing  of  the  nose, 
sniffing  cold  water  up  the  nostrils,  or  water  with  vinegar 
or  alum,  or  a  little  hydrated  sesquichloride  of  iron.  In  ex- 
treme cases,  the  nostrils  may  be  plugged  with  bits  of  sponge, 
a  rolled  piece  of  linen,  or  a  pledget  *  dipped  in  vinegar  or 
in  a  solution  of  alum.  A  very  good  and  easily  applicable 
^means  is  to  press  on  the  soft  part  of  the  nose  for  five  to  ten 
minutes.  But  herein,  as  well  as  in  plugging,  the  flow  of  blood 
down  the  throat  must  be  prevented.  If  this  takes  place, 
the  openings  of  the  nose  into  the  throat  must  also  be  plugged, 
but  only  by  a  physician. 

(d)  Uterine  bleedings.  Severe  hemorrhage  from  the 
genitals,  although  a  loss  of  blood  from  these  organs  is  not  so 
dangerous  to  women  as  bleedings  from  other  parts,  may 
soon  become  dangerous.  Such  bleedings  are  nearly  always 
connected  with  the  puerperal,  or  lying-in,  period.  During 
the  first  months  of  pregnancy,  they  occur  with  abortion,  or 
at  least  they  bring  on  the  danger  of  abortion.  During  the 
later  months,  they  are  symptoms  of  placenta  prcevici  (an 
insertion  of  the  placenta  over  the  mouth  of  the  womb  in- 
stead of  on  the  fundus),  and  result  from  it  :  a  condition 
which  is  very  dangerous  to  both  mother  and  child.  In 
both  cases,  an  absolutely  quiet  position  is  the  first  thing 

"  Pledgets,  or  compresses  of  lint,  are  made  by  arranging  the  filaments 
parallel  to  eaxib  other,  and  by  passing  around  the  middle  a  thread  of  linen  or 
silk.  The  ends  of  th^^  thread  are  convenient  for  pulling  the  pledget  out  from 
the  wound  or  caviij. 

10 


218  FIRST   HELP   IN   CASES    OF   LESIONS. 

necessary,  with  the  head  a  little  lowered  and  the  pelvis 
elevated,  if  possible.  Cold  applications  around  the  lower 
abdomen,  and,  if  possible,  the  plugging  of  the  vagina  by 
pieces  of  cotton  or  old  linen,  are  of  service.  At  all  events, 
the  physician  must  be  called  in  as  soon  as  possible. 

During  delivery  itself  the  bleeding  may  also  become 
profuse,  and  endanger  the  life  of  the  mother.  These  bleed- 
ings are  caused  by  the  want  of  uterine  contraction  after  the 
expulsion  of  the  child,  or  by  the  contractions  not  being 
permanent.  The  hindrance  to  the  contractions  is  generally 
in  the  placenta,  which  may  have  grown  on,  either  partly 
or  wholly,  or  may  have  become  locked.  The  same  posi- 
tion of  the  body,  and  cold  applications  on  the  abdomen,  as 
above.  But  the  plugging  of  the  vagina  is  of  no  use  in  this 
case.  The  best  thing  is  to  rub  and  knead  the  uterus, 
which  may  be  felt  through  the  abdominal  wall,  and  by 
this  means  to  excite  it  to  contraction.  In  this  case,  also, 
even  should  a  midwife  be  present,  a  medical  man  should  be 
summoned  immediately.  * 

III.— FIRST  HELP  IN  CASES  OF  LESIONS. 

1.  Bruises  and  contusions.  Cold  applications,  ice,  lead- 
water. 

2.  Bleeding  from  wounds.  Here,  temporary  help  con- 
sists of  checking  the  flow  of  blood,  and  putting  on  the  first 
bandage.  The  principal  means  of  stopping  the  flow  of 
blood,  which  may  be  employed  by  non-professional  persons, 
are :  pressure  (either  directly  on  the  wound,  or  on  the 
artery  conveying  the  blood  to  the  wound),  cold,  and  the 
so-called  styptic  means  (astringents). 

*  Bleedings  from  placenta  prievia.  and  in  consequence  of  the  placenta 
having  become  fixed,  often  have  a  suddenly  fatal  issue.  In  the  case  of  tlieir 
occurrenea  the  administration  of  th«  saci-araBiits  should  not  he  dnlave*!. 


FIRST   HELP   IN   CASES    OF   LESIONS.  219 

Bleeding  may  be  stopped  by  direct  pressure  on  the 
wound,  or  on  the  bleeding  edges  of  the  injured  artery,  if 
the  blood  flows  out  slowly,  not  in  jets ;  also,  if  it  comes 
from  the  capillaries  (the  minutest  blood-vessels),  or  from 
the  superficial,  although  larger,  veins,  or  from  the  smallest 
arteries.  In  such  cases,  pressure  should  be  made  on  the 
wound  with  a  sponge  or  compress  that  has  been  dipped 
into  cold  water  and  well  squeezed  afterward.  After 
these  applications  have  been  made  for  some  considerable 
time,  during  which  pressure  and  cold  work  simultaneously, 
a  thick  pledget,  either  dry  or  wet,  is  placed  upon  the 
wound  and  bound  tightly,  so  that  the  pressure  of  the 
pledget  stops  the  bleeding.  In  bleedings  from  very  deep 
wounds,  the  wound  must  often  be  stuffed  with  pieces  of 
sponge  or  with  lint,  if  no  one  of  the  bystanders  can  sew  them 
together  firmly  and  closely.  If  the  wound  be  of  consider- 
able extent  (for  instance,  large  lacerations,  tearing  off  of 
limbs),  and  the  bleeding  cannot  be  checked  by  these  means, 
the  whole  current  of  blood  must  be  stopped  by  pressure 
on  that  artery  which  conveys  the  blood  to  the  wound. 
This  kind  of  pressure  is  always  necessary,  if  an  artery  of 
medium  size  be  wounded.  The  blood  from  a  wounded 
artery  escapes  in  jets;  it  can  be  distinguished  by  this 
feature  from  hemorrhage  of  the  veins,  from  which  the 
blood  escapes  in  jets  only  when  a  ligature  has  been  applied 
for  venesection,  by  which  the  current  of  the  blood  is 
hindered.  The  arteries  convey  the  blood  from  the  heart 
to  the  organs ;  consequently,  in  order  to  stop  bleeding 
from  them,  pressure  or  a  ligature  must  be  applied  on  the 
conveying  trunks,  above  the  wound,  toward  the  heart. 
Ligatures  can  be  applied  only  by  a  physician.  Temporary 
lielp  should  simply  consist  in  closing  the  artery  by  pressure 
till  medical  assistance  can  be  obtained.     First,  the  artery  is 


220  FIRST   HELP   IN   CASES   OF   LESIONS. 

sought  above  the  wound,  toward  the  trunk :  it  is  felt  pulsat- 
ing under  the  finger.  An  artery  can  be  closed  by  pressure 
only  in  places  where  there  is  some  support  underneath, 
that  is,  on  parts  where  the  artery  is  nearly  superficial  and 
at  the  same  time  on  or  near  a  bone.* 

*  The  most  convenient  and  best  points  for  compressing  the  arteries  are: — 

The  common  carotid  artery.  At  the  top  of  the  larynx,  press  the  same 
backward,  and  somewhat  interiorly,  against  the  vertebral  column.  Pressure 
cannot  be  kept  up  long,  on  account  of  important  nerves  lying  between  the 
artery  and  the  vertebral  column  that  cannot  bear  continued  pressure.  For 
facial  hemorrhages. 

External  maxillary  artery.  At  the  anterior  edge  of  the  large  masseter 
muscle,  press  against  the  edge  of  the  jaw. 

Temporal  artery.  2-3  lines  (^-|  centimeter)  in  front  of  the  angle  of  the 
opening  of  the  ear  against  the  temporal  bone.  Branches  of  the  same  are 
easily  felt,  and  even  seen,  at  the  temples  and  foreheads  of  elderly  people, 
and  may  be  easily  compressed  against  the  skull.  In  bleeding  of  the  fore- 
head and  the  front  part  of  the  scalp. 

Subclavian  artery.  Draw  the  shoulder  well  forward,  and  press  from 
above  the  collar-bone  deeply  against  the  first  rib.  Kather  difficult;  very 
successful  only  with  lean  persons.     In  bleeding  of  the  axilla  and  upper-arm. 

Axillary  artery.  Between  the  anterior  and  middle  third  of  the  armpit,  at 
the  anterior  edge  of  the  hairy  growth,  press  against  the  head  of  the  humerus 
(arm-bone).    The  arm  should  be  elevated.    In  bleeding  of  the  arm  or  hand. 

Bradiial  artery.  On  the  inner  side  of  the  upper-arm,  at  the  inner  edge  of 
ihe  thick  biceps  muscle,  against  the  bone  of  the  upper-arm.  Care  should  be 
taken  to  sepaiate  by  taxis,  as  much  as  possible,  the  artery  from  the  accom- 
panying nerves,  that  these  may  not  be  injured.     In  bleeding  of  the  fore-arm. 

Radial  artery.  One  half-inch  (1-2  centimeters)  above  the  wrist,  one  centi- 
meter from  the  edge  of  the  arm,  press  against  the  radius.  At  this  point  the 
pulse  is  usually  felt.  In  bleeding  of  the  radial  side  of  the  hand,  thumb  and 
index-finger. 

Ulnar  artery.  At  the  same  distance  from  the  wrist,  and  the  same 
distance  from  the  ulnar  edge  of  the  arm,  press  against  the  ulna.  In  bleeding 
of  the  ulnar  side  of  the  hand,  middle,  ring,  and  little  finger. 

Femoral  artery.  In  the  grcin,  about  the  nnddle  (a  little  internally), 
betw^een  the  median  line  and  the  anterior  prominence  of  the  hip-bone, 
against  the  pubis,  press  backward  and  upward.  Lower  down,  as  far  as 
the  middle  third  of  the  femur,  compression  of  the  artery  may  also  be  made; 
but  it  is  not  as  safe,  and  only  to  be  resorted  to  in  case  of  inguinal  hernia  or 
other  swelling  in  the  region  of  the  groin.     In  bleeding  of  the  leg  or  foot. 

Less  safe  is  the  compression  of  the  posterior  tibial  artery,  back  of  the 
inner  condyle,  ag'ainst  the  condyle,  in  bleeding  of  planta  pedis  ;  of  tiie 
pedal  artery,  by  the  side  of  the  extensor  tendon  of  the  big  toe  at  the  outer 
side  against  the  cuboid  bone;  in  bleeding  of  the  back  of  the  foot. 

The  descending  abdominal  artery  and  artery  of  the  pelvis  may  be  compressed 
through  the  thin  abdominal  walls  against  the  vertebral  column  and  bones  of 
the  pelvis,  but  the  pressure  is  not  readily  borue.  In  bleeding  of  the  inguinal, 
penneal,  rectal,  etc,  region. 


FIRST   HELP   IN   CASES   OF   LESIONS.  221 

Whether  the  pressure  is  sufficient  to  close  the  artery, 
can  be  best  found  out,  in  such  a  case,  from  the  stoppage 
of  bleeding,  or  at  least  of  bleeding  in  jerks.  The  most 
convenient  means  for  making  pressure  is  the  hand,  or  the 
ends  of  the  fingers  respectively.  The  finger  feels  the 
artery  and  can  compress  it  in  a  sure  way.  without,  at  the 
same  time,  pressing  and  sq[ueezing  other  parts.  Care 
must  be  taken  not  to  press  more  strongly  than  is  necessary 
to  stop  the  bleeding :  too  much  pressure  cannot  long  be 
borne  by  the  patient,  and  the  fingers  soon  tire.  If  the 
pressing  of  the  fingers  cannot  be  made  use  of  on  account 
of  fatigue  or  of  necessary  removal,  a  so-called  tourniquet 
must  be  used.  Of  course,  tourniquets  made  expressly  for 
the  purpose,  the  pledgets  of  which  are  placed  on  the  artery 
and  tightened  by  means  of  a  screw,  are  generally  not  at 
hand.  But  a  temporary  contrivance  can  be  readily  made. 
A  roller  is  placed  on  the  artery  ;  then  a  small  compress,  a 
hard  pad  of  lint  (or  a  potato  or  a  stone  wrapped  in  linen), 
a  bandage,  or  a  folded  pocket-handkerchief,  is  tied  around, 
loosely,  but  with  a  firm  knot.  A  stick  is  then  pushed 
beneath  the  circular  bandage  thus  formed,  between  it  and 
the  skin,  on  the  side  opposite  the  artery,  and  twisted 
slowly,  so  that  it  screws  the  handkerchief  or  the  bandage 
tight,  till  the  blood  ceases  to  flow.  The  stick  is  then 
fastened  parallel  in  its  length  with  the  direction  of  the  limb. 
In  order  to  protect  the  skin,  it  is  advisable  to  place  a 
piece  of  paste-board,  or  a  thin  board,  etc.,  beneath  the  screw. 
In  extreme  cases,  the  tourniquet  can  be  made  thus  :  a  folded 
handkerchief  or  bandage  is  loosely  tied  around  the  limb, 
placing  the  knot  itself  as  a  pledget  upon  the  artery,  and 
then  twisting  by  means  of  the  gag.  The  tourniquet  may 
be  placed  on  the  wound  itself,  if  it  is  small.  In  this  case 
the  wound  and  the  artery  will  close  at  the  same  time. 


222  FIRST   HELP   IN    CASES    OF   LESIONS. 

All  such  tourniquet-bandages  must  not  be  left  on  too 
long,  because  they  arrest  the  circulation  in  the  peripherical 
end  of  the  limb. 

Professor  Esmarch*  recommends  (after  Adelmann),  in 
order  to  stop  temporary  bleedings  from  the  arteries  of  the 
fore-arm,  or  hand,  or  lower  part  of  thigh  and  foot,  a  forced 
bending  of  the  elbow  and  hip-joint,  by  which  the  trunks  of 
the  arteries  are  so  much  bent  that  they  allow  no  blood  to 
pass.  The  bent  fore-arm  is  bound  as  tightly  as  possible  to 
the  upper-arm,  and  the  femur,  turned  as  much  as  possible, 
is  bound  to  the  body.  If  there  be  no  other  way  to  stop 
the  bleeding,  this  method  may  be  tried  ;  although  the  forced 
bending  of  the  joints  cannot  be  borne  long. 

When  the  bleeding  stops,  the  wound  is  simply  dressed 
in  a  loose  manner.  But  the  dressing  has  to  be  carefully 
attended  to,  lest  the  bleeding  return  beneath  it  unnoticed. 

Bleeding  from  smaller  vessels  may  be  arrested  by  cold 
— cold  compresses,  ice,  freezing  mixtures.  Cold  causes  the 
vessels  to  contract :  small  vessels  contract  so  that  they  be- 
come totally  closed.  In  olden  times,  there  was  scarcely 
any  other  means  of  stopping  bleedings  known  than  actual 
cautery  by  hot  iron,  red-hot  knives,  dipping  into  hot  pitch 
or  boiling  oil,  etc.  Nowadays  cautery  is  employed  in  very 
rare  cases,  and  can  be  used  by  physicians  only. 

Styptics  will  generally  arrest  the  bleeding  from  small 
vessels,  but  they  have  the  disadvantage,  that  the  wounds 
thus  treated  do  not  heal  through  direct  union,  but  only 
through  formation  of  matter  (suppurations).  It  is  best, 
therefore,  to  arrest  or  conti-ol  the  bleeding  till  the  phy- 
sician's arrival,  if  possible,  without  making  the  wound 
unclean.     The  following  are  styptics :  flour,  powdered  char- 

*  Esmarch,  Dr.  Fr.,  Handbuch  der  kriegschirurgUchen  Ttcknik.  Haa- 
uover,  1877  :  Carl  Eumpler. 


FIRST   HELP   IN   CASES   CF   LESIONS.  223 

coal,  alum,  tannin,  lunar  caustic,  acetate  of  lead,  proto- 
chloride  of  iron,  sulphate  of  iron  and  sulphate  of  copper, 
alcohol,  diluted  sulphuric  acid,  oil  of  turpentine.  Alum, 
liquor  sesquichloride  of  iron  {liquor  ferri  sesquichlorati), 
tannin,  oil  of  turpentine,  are  to  be  preferred.  These 
styptics  are  either  injected  into  the  wounds  as  solutions, 
or  a  plug  of  lint,  or  a  sponge,  dipped  into  these  solutions, 
is  put  on,  or  the  dry  substances  are  strewed  on  the  wounds, 
either  pure  or  mixed  with  powdered  gum  arable  ;  or  cotton 
or  lint,  over  which  the  powder  has  been  strewed,  is  placed 
on  the  bleeding  spot  and  fastened  with  strips  of  sticking- 
plaster  or  bandages. 

In  cases  in  which  leech-bites  bleed  too  long,  the  flow 
may  be  arrested  by  patient  pressure  of  a  piece  of  punk,  or 
it  may  be  checked  by  the  finger  alone.  In  children,  ex- 
cessive bleeding  from  leech-bites  may  often  become  very 
dangerous.  If  there  is  no  firm  support  underneath  to 
enable  adequate  pressure  to  be  applied,  it  is  best  to  grasp 
the  skin,  where  the  bite  is  situated,  in  a  fold,  and  to  press 
this  fold  till  the  flow  is  checked. 

There  are  certain  persons  called  ^'  bleeders,"  in  whom  a 
hemorrhagic  diathesis  exists.  This  constitutional  defect  is 
not  often  met  with,  and  is  generally  hereditary.  In  such, 
the  most  trifling  wounds  are  often  followed  by  profuse,  and 
sometimes  fatal,  bleeding.  If  a  person  or  a  family  is 
known  to  have  this  hereditary  defect,  the  most  energetic 
means  (tourniquets)  to  stop  the  flow  must  be  employed, 
and  the  physician  must  be  sent  for,  even  in  case  of  trifling 
lesions,  or  spontaneous  bleeding. 

3.  In  the  event  of  a  cavity  of  the  body  having  become 
opened  by  a  wound,  we  must  not  only  stop  the  bleeding, 
but  also  see  whether  any  of  the  contents  of  the  cavity,  for 
instance,  a  part  of  the  intestines,  have  protruded.     The 


224  FIRST   HELP   IN    CASES   OF   LESIONS. 

protruded  parts  must  be  gently  pushed  ba.ck,  after  tliey 
have  been  cleansed  from  any  dirt  with  tepid  water.  Then 
the  wound  must  be  closed  by  means  of  adhesive  plaster, 
or  bandages  put  over  compresses ;  at  least,  so  as  to  keep 
the  protruded  parts  in  their  place.  If  the  brain  is  laid 
open,  any  handling  of  it  must  be  avoided }  and,  to  protect 
it  from  the  external  air  and  dust,  a  light  handkerchief  is 
laid  loosely  over  the  head. 

It  is  of  absolute  necessity  to  close  such  wounds  as  have 
perforated  an  important  cavity  of  the  body,  as  soon  as 
possible ;  it  is  also  useful  in  so-called  flesh-wounds,  on 
account  of  the  subsequent  inflammation  and  healing.  After 
checking  the  more  copious  bleeding,  the  wound  should 
be  closed  j  the  edges  of  the  wound  being  exactly  adjusted 
and  kept  together  by  a  closely-fitting,  but  not  too  tight, 
dressing. 

4.  In  fractures  of  the  hones,  the  main  thing  is  to  have 
the  broken  limb  in  the  easiest  position  possible,  and  to 
keep  it  quiet,  so  that  painful  frictions  of  the  ends  of  the 
bone,  greater  dislocations,  and  ruptures  of  vessels,  may 
be  avoided.  If  the  removal  of  the  sufferer  is  necessary, 
he  should  be  carried  on  a  bed,  litter,  or  at"  least  in  such  a 
manner  that  the  broken  parts  are  properly  supported,  and 
movements  of  the  place  of  fraction  avoided.  After  the 
broken  part  has  been  somewhat  straightened,  splints  made 
of  wood  or  paste-board,  or  long  pads  of  straw,  should  be 
placed  along  both  sides  of  the  limb,  and  should  be  fastened 
with  bandages  or  layers  of  cloth,  for  tlie  purpose  of  keeping 
the  limb  steady.  It  is  very  useful  to  place  the  injured  parts 
between  long  pillows,  or  sacks  filled  loosely  with  sand  :  these 
can  be  made  nearly  everywhere,  and  quickly  :  besides,  the 
limb  remains  accessible  to  refrigerant  applications.  Till 
the  physician  arrives,  cold  lotions,  ice,  dressings  of  lead- 


FIRST   HELP   IN   CASES   OP   LESIONS.  225 

water,  should  be  applied  to  the  fracture.     The  same  applies 
to  sprains. 

5.  Burns  and  scalds.  Very  slight  burns/ of  the  so-called 
first  degree,  wherein  the  skin  is  merely  reddened  without 
rising  into  blisters  (vesications),  require  only  to  be  pro- 
tected from  the  air,  and  to  be  rubbed  with  grease  or  oil. 
The  main  thing  in  burns  of  the  second  degree,  that  is,  if 
blisters  have  risen,  is  also  protection  from  the  air.  For 
this  purpose,  the  burnt  parts  are  wrapped  in  cotton,  and 
covered  with  fine  rags  saturated  with  oil,  grease,  cod-liver- 
oil,  yolk  of  eggs,  etc.  If  a  drug-store  is  near,  a  so-called 
lime-liniment,  consisting  of  equal  parts  of  lime  water  and 
linseed  oil,  should  be  used  to  moisten  the  rags.  Lacera- 
tion of  the  blisters  must  be  carefully  avoided  ;  after  twelve 
to  twenty-four  hours  have  elapsed,  they  may  be  opened  with 
fine  needles. 

Extensive  burns  of  the  second  degree  are  dangerous  to 
life.  If  more  than  one-third  of  the  surface  has  been  burnt 
in  the  second  degree,  the  condition  is  very  critical,  and 
leads  very  often  to  fatal  issues. 

Cases  of  greater  injury,  where  the  skin  is  broken,  or 
where  the  outer  skin  is  destroyed  even  to  the  charring  of 
the  parts  beneath,  require,  first,  the  application  of  cold- 
water  dressings  to  relieve  the  violent  pains.  After  reliev- 
ing the  greatest  pain,  tepid  dressings  of  chamomile  tea  are 
very  useful. 

.  A  similar  treatment  is  applicable  to  cases  of  injury  by 
caustic  substances.  First  of  all,  the  skin  must  be  cleansed 
from  the  oftending  substances,  not  so  much  by  washing 
and  rubbing,  as  by  rinsing.  Water  is  always  at  hand, 
and,  if  applied  in  large,  and  often-renewed,  quantities,  will 
go  far  to  remove,  or  at  least  to  thin  out,  the  caustic  sub- 
stances.   It  may  be  of  service  to  add  to  the  water  substances 


226  CASES   OF   POISONING. 

which  neutralize  the  respective  corrodents.  If  the  injury- 
was  done  by  acids  (sulphuric  acid,  vitriol,  nitric  acid),  add 
to  the  rinsing  water  some  chalk,  soap,  magnesia,  soda, 
but  not  much,  lest  the  injured  skin  be  again  irritated ;  if 
done  by  lime  or  lye,  add  some  vinegar.  No  time  should 
be  lost  in  fetching  these  things,  but  a  good  rinsing  with 
water  should  be  first  applied. 


IV.— CASES  OF  POISONING. 

There  is  reason  to  suspect  a  case  of  poisoning  if  a 
person  is  suddenly  taken  ill  after  having  partaken  of  any 
kind  of  food  or  drink,  and  if  the  following  symptoms  are 
met  with :  nausea,  retching,  vomiting,  pain  in  the 
stomach  and  intestines,  diarrhoea,  difiiculty  of  breathing, 
sense  of  suffocation,  violent  hiccoughing  j  or,  vertigo, 
fainting,  stupor,  coma,  giddiness,  delirious  talking,  con- 
vulsions, palsy  in  the  limbs.  The  former  set  of  symptoms 
indicate  poisoning  by  corrosive  and  irritant,  the  latter,  by 
narcotic,  stupefying,  poisons. 

To  remove  at  once  the  poisoning  substance  from  the 
stomach  and  intestines,  or  to  hinder  its  absorption,  is  the 
result  to  be  sought  for.  Evacuation  of  the  stomach  by 
vomiting  is  promoted  by  copious  draughts  of  warm  water, 
salt-water,  warm  water  and  butter,  egg-water  (one  eg^  to 
half-a-pint  of  water),  tepid  milk  ;  also  by  tickling  the  fauces. 
Emptying  the  stomach  of  its  contents  by  the  stomach- 
pump  should  be  done  by  physicians  only  j  nor  should  medi- 
cinal emetics  be  used  without  the  advice  of  a  physician. 

From  the  intestines  the  poison  may  be  emptied  by  clys- 
ters, or  by  taking  oil — castor-oil.  Oil  must  not  be  used,  if 
the  poisoning  is  known  to  result  from  phosphorus. 


CASES   OF  POISONING.  227 

For  enveloping  the  (irritant)  poison,  strong  sugar- water, 
water  and  albutnen.  pure  albumen,  milk,  oatmeal  gruel, 
etc.,  may  be  used. 

This  is  all  that  can  be  done  in  many  cases,  for,  generally, 
the  nature  of  the  poison  is  not  known,  and  non-professional 
persons  cannot  make  inferences  from  the  symptoms. 

If  the  poisonous  substance  be  known,  it  may  be  rendered 
inert,  or  its  effects  counteracted,  by  appropriate  chemical 
reagents  (so-called  counter-poisons).  Cases  of  poisoning 
occur  more  commonly  by  : 

Arsenic :  as,  arsenious  acid  (white  arsenic),  or  arsenic 
combines  (realgar  and  orpiment,  arsenious  cobalt,  paris- 
green),  etc. 

Antidote :  ferrum  hydricum  in  aqua  (hydrated  sesqui- 
oxide  of  iron,  hammer-slakes,  or  iron  sparklings,  from  the 
blacksmith's  podge).  Every  quarter  to  half  an  hour,  one 
to  two  tablespoonfuls.  For  arsenious  salts,  ferrum  hydrico- 
aceticum  in  aqua  (liquor  acetate  of  iron)  is  still  better ;  every 
quarter  to  half  an  hour,  one  teaspoonful  with  water.  If 
this  cannot  be  had,  calcined  magnesia  and  water  (two  ounces 
in  a  cup  of  water),  in  tablespoonfuls.  Glauber's  salt,  one 
ounce,  to  evacuate  the  intestine. 

Lead :  white  lead,  sugar  of  lead,  liquor  subacetate  of 
iron. 

Antidote:  Glauber's  salt,  epsom  salts  (12  drachms  to 
half-a-pint  of  water),  every  quarter  to  half  an  hour,  one 
tablespoonful ;  castor-oil  clysters. 

Copper:  verdigris  (acetate  of  copper),  gome  green  colors. 

Antidote  :  much  albumen,  mush  of  iron-filings,  7  parts, 
and  flower  of  sulphur,  4  parts,  in  water  or  syrup  j  copious 
drinks. 

Mercury :  corrosive  sublimate,  calomel,  cinnabar  or 
vermilion. 


228  CASES   OF  POISONING. 

Antidote  :  albumen,  flour  mixed  in  water,  powdered  iron 
in  syrup,  milk,  sugar  and  water. 

Silver:  lunar  caustic  (nitrate  of  silver). 

Antidote :  copious  draughts  of  a  strong  solution  of 
chloride  of  sodium  (table-salt  in  water). 

Iodine  and  iodide  of  potassium. 

Antidote :  starch  paste  in  large  doses,  sugar-water, 
magnesia. 

Thospliorus :  matches. 

Antidote :  magnesia  in  water,  as  above  under  arsenic* 
(No  oil.) 

Caustic  alkalies :  caustic  potash,  concentrated  solution 
of  caustic  soda  (lyes),  lime,  liquid  ammonia  (spirit  of 
hartshorn). 

Antidote :  lemon-juice,  acetic  lemonades,  vinegar,  sweet 
almond-oil. 

Corrosive  acids:  nitric  acid,  muriatic  acid,  sulphuric 
acid  (oil  of  vitriol).  The  characteristic  of  these  poisons 
is  the  inflammation  of  the  mouth  and  throat,  with  pain  in 
the  throat,  coughing,  vomiting  of  membranous  matters, 
often  bloody  stools. 

Antidote  :  carbonate  and  calcined  magnesia,  chalk,  solu- 
tion of  soap,  milk. 

Tartar  emetic. 

Antidote:  strong  coffee  or  green  teaj  tannin,  16  grains 
every  hour. 

Vegetable  poisons  :  narcotic  or  narcotico-acrid  poisons ; 
such  are  opium,  belladonna,  henbane,  savin,  tansy,  conium, 
tobacco,  lobelia,  digitalis,  aconite,  veratrum,  Calabar-bean, 
woorara,  nux  vomica  (containing  strychnia),  and  many 
more  less  known.  To  these  may  be  added ;  chloroform, 
laudanum,  ergot,  croton-oil,  poisonous  fungi. 

Antidotes :    vinegar,    citric   acid,    lemon-juice,    strong 


CASES   OF  POISONING.  229' 

black  coffee.  If  there  is  great  failing,  spirit  of  hartshorn, 
15-30  drops  in  coffee,  water,  oatmeal  or  barley-gruel. 
Cold  clysters,  to  which  10-20  drops  of  spirit  of  hartshorn 
are  added.  Vomiting  is  to  be  brought  on  ;  cupping-glasses 
on  the  neck  and  back  along  the  vertebral  column.  Cold 
applications  and  effusions  on  the  head. 

Animal  poisons y  taken  by  the  mouth,  are  the  poisons 
formed  in  decomposing  sausage,  cheese,  fish,  cantharides, 
bad,  poisonous  bivalves.  They  cause  flatulence  of  the 
stomach,  vomiting,  diarrhoea.  Mussels  cause,  also,  red  or 
puffy  blotches  over  the  skin  and  mucous  membranes  like 
severe  nettle-rash,  even  complete  swelling  of  the  throat. 
Cantharides  (Spanish  flies)  cause  retention  of  urine. 

Antidotes :  carbonate  of  ammonia,  spirit  of  hartshorn, 
black  coffee,  lemonade,  wine,  mucilaginous  drinks  j  cold 
applications  to  the  head. 

Poisoning  through  bites,  stings,  or  other  infection,  from 
venomous  or  diseased  animals.  Poison  of  wasps,  flies, 
serpents,  mad  dogs  j  poison  developed  in  inflammation  of 
the  spleen. 

Antidotes  :  the  wounded  part  may  be  washed  with  lime- 
water,  vinegar,  diluted  muriatic  acid,  acetic  acid,  chlorine- 
water,  green  soap,  wood-ash  lixivium  ;  or  it  may  be  sucked 
out  by  cupping-glasses.  The  cauterization  of  such  wounds, 
either  with  the  hot  iron,  or  with  powerful  chemical  agents, 
such  as  lunar  caustic,  muriatic  acid,  caustic  potash,  etc., 
as  well  as  excision  of  the  wounded  part,  must  be  left  to 
the  physician.  If  the  wound  is  on  a  limb,  it  may  be  of 
avail  to  place  a  ligature  above  the  bitten  part,  in  order 
to  hinder  the  entrance  of  the  poison  into  the  system.  Yet 
such  a  ligature  should  only  be  applied  in  well-ascertained 
and  dangerous  cases  of  violent  poisonings ;  for  instance, 
by  mad  dogs  or  venomous  serpents,  because  the  part  of  the 


230  CASES   OF   POISONING. 

limb  below  the  ligature  is  exposed  to  the  danger  of  becom- 
ing gangrenous.  Internally,  the  same  antidotes  as  against 
animal  poisons  taken  by  the  mouth  should  be  given. 

If  a  case  of  hydrophobia  is  developed  in  a  human  being, 
the  patient  must  be  prevented  from  doing  any  injury  to 
himself  or  others.  All  sharp  instruments,  and  articles  of 
furniture  with  keen  edges,  must  be  removed  ;  if  necessary, 
the  struggles  of  the  patient  must  be  restrained  by  strait- 
jacket.  He  should  be  made  to  swallow  small  pieces  of 
ice,  and  inhale  small  quantities  of  chloroform  (forty  to 
sixty  drops  on  a  towel  held  before  the  mouth).  That 
abominable,  superstitious  belief  must  be  guarded  against, 
that  it  can  be  allowable  to  free  those  sufferers  from  their 
terrible  affliction  more  quickly  by  suffocating  them  with 
pillows,  or  by  letting  them  bleed  to  death,  or  by  any  violent 
anticipation,  of  any  sort  or  kind,  of  its  natural  course. 


L .— :nuesin(}  the  sick. 


The  great  majority  of  people  are  not  able  to  procure  a 
trained  sick-nurse,  when  Providence  afflicts  any  member  of 
the  family.  Outside  of  hospitals,  nursing  of  the  sick  by 
attendants  specially  trained  is  the  exception  j  nursing  by 
the  relatives,  the  rule. 

The  proper  management  of  the  sick-room  is  of  very 
great  importance,  and  not  an  easy  matter.  I  may  say, 
without  efficient  nursing,  medical  art,  in  a  great  many 
cases,  is  rendered  almost  powerless.  Let  us,  for  instance, 
take  the  dietetical  regimen.  In  health,  diet  may  be  left  in 
great  measure  to  inclination ;  and  carelessness  and  faults, 
with  regard  to  rational  diet  in  the  case  of  healthy  persons, 
pass,  perhaps,  with  impunity,  whilst  they  end  in  great 
damage  to  the  invalid.  On  the  one  hand,  his  disordered 
system  lacks  the  power  of  resistance  to  noxious  agents, 
and,  on  the  other,  he  cannot  ward  them  off  at  his  own  choice. 
A  person  in  health,  for  instance,  eats  nothing  that  does  not 
agree  with  him,  goes  into  the  open  air  when  the  room 
becomes  too  damp  or  close,  selects  his  clothing,  heavier  or 
lighter,  as  suits  him,  etc.,  etc.  But  the  invalid  has  to  eat 
what  is  given  to  him,  or  has  perhaps  perverted  desires  ;  he 
is  constrained  to  remain  in  bed  and  in  the  sick-room :  he 
depends  in  all  upon  his  attendants.     The  latter  choose  his 


232  NURSING  THE   SICK. 

nourisliinent,  take  care  of  the  cleanliness  of  his  person  and 
his  room,  have  the  care  of  his  bed,  have  to  cover,  to  lift, 
and  to  turn  him. 

Furthermore,  how  can  the  directions  of  the  physician 
be  executed  properly  by  the  invalid,  even  if  he  wished  to 
do  so  ?  The  taking  of  medicine,  for  instance,  is  not  the 
most  important  of  these  matters  :  yet,  even  in  this  respect, 
many  sick  persons  are  sometimes  neglectful  and  stubborn, 
whilst,  often,  they  are  rendered  unable  to  kelp  themselves 
by  their  weakness,  or  by  the  delirium  of  fever.  The 
warding-off  noxious  agents,  certain  operations  and  hand- 
lings of  the  body,  must  be  left  partly  or  entirely  to  the  help 
and  assistance  of  others,  etc.,  etc. 

Certainly,  the  proper  management  of  the  sick-room  is  a 
matter  of  no  mean  importance.  Yet  few  persons  have  any 
knowledge  of  the  various  important  duties  connected  with 
it ;  and  it  is  astonishing  how  few  take  any  pains  to  acquire 
the  requisite  information,  although  they  are  likely  to  be 
called  upon  to  fulfil  these  duties,  not  only  in  attendance 
upon  strangers,  but  even  upon  those  Avho  are  most  dear  to 
them  in  life.  Our  schools  do  not  give  information  upon 
these  matters :  the  young  married  couples  know  them  not. 
Hence  the  incredible  negligence  and  ignorance,  hence  the 
really  perplexing  and  unyielding  indocility  in  these  impor- 
tant matters ;  hence,  likewise,  the  many  faults  and  mistakes 
committed  in  this  respect, — mistakes  which  are  not  seldom 
followed  by  very  injurious  consequences.  This  accounts, 
too,  for  the  many  absurd  and  superstitious  notions  and 
prejudices  about  diseases  and  nursing  which  retain  an 
obstinate  hold  on  the  people,  and  by  which  the  door  is 
thrown  wide  open  to  the  tomfoolery  of  old  women,  quacks, 
and  frauds.  This  state  of  things  prevails,  not  only  in 
country  districts  and  in  the  lower  ranks  of  society,  but 


NURSING  THE   SICK.  233 

every  pliysician  can  bear  testimony  that,  from  the  beggar 
to  the  banker,  he  has  to  combat,  in  many  respects,  tlie  same 
ignorance,  the  same  prejudices,  the  same  perverted  and 
absurd  notions. 

It  is  not,  of  course,  my  object  to  write  a  complete  trea- 
tise on  everything  that  pertaias  to  nursing ;  I  only  want 
to  call  particular  attention  to  a  few  points,  in  order  to  enable 
the  priest  to  exercise  a  beneficial  superintendence  over  the 
nursing  of  his  sick  penitents.  It  will  afford  him,  at  times, 
an  opportunity  of  averting  by  his  suggestions  the  greatest 
evils  5  of  obtaining  for  the  sick  great  alleviation  of  their 
sufferings,  and,  perhaps,  of  saving  human  life  from  the 
results  of  stubborn  stupidity. 

The  first  rule  to  be  observed  in  a  case  of  serious  disease 
is,  that  a  physician  must  be  called  in.  The  priest  must 
insist  on  this  point,  as  well  as  resist  all  applications  for 
medical  counsel  from  persons  who  wish  to  avoid  calling  in 
a  regular  medical  practitioner.  In  the  case  of  persons 
who  are  able  to  pay,  parsimony  is  frequently  the  motive 
for  their  reluctance.  In  the  case  of  poor  people,  the  neglect 
to  secure  medical  treatment,  although  it  will  cost  them 
nothing,  arises,  often  enough,  from  sheer  indifference  and 
idleness.  By  this  neglect,  a  disease,  easily  remediable  at 
first,  may  become  firmly  rooted  in  the  constitution,  or  it 
may  even  have  a  fatal  issue. 

The  second  necessary  requisite  for  efficient  nursing 
must  be,  strict  obedience  to  all  the  directions  of  the  phy- 
sician. It  is  not  only  negligent  and  inattentive  people  of 
the  uneducated  classes  in  whom  the  belief  is  firmly  rooted 
that  the  taking  of  ^'  medicine"  is  sufficient,  but,  even 
amongst  the  higher  and  more  educated  classes,  it  is  not 
unseldom  the  case  that  a  great  variety  of  disagreeable  and 
expensive  medicines  is  swallowed  with  precise  regularity 


234  NURSING   THE   SICK. 

for  weeks  and  months,  whilst  the  most  simple,  but  impor- 
tant, directions  of  the  physician  in  reference  to  diet  and 
other  hygienic  observances  are  set  aside  with  incredible 
carelessness.  This  is  one  of  the  conwnon  kinds  of  devia- 
tion from  medical  orders.  Another  kind  is  the  asking  for, 
or  listening  to,  the  advice  of  more  or  less  plausible  indi- 
viduals, and  being  guided  by  it,  even  whilst  under  the 
treatment  of  the  physician.  People  who  act  thus,  think 
they  are  imposing  on  the  latter  :  they  are  in  reality  imposing 
on  themselves.  It  is  by  no  means  uncommon  to  hear 
such  observations  as  the  following — made,  too,  with  a  kind 
of  self-complacent  exultation :  "  I  did  not  take  what  the 
^  doctor '  prescribed,  but  I  used  this,  I  did  that,  and  now  I 
am  cured."  Very  well,  there  is  nothing  to  be  said  against  a 
patient  taking  his  cure  into  his  own  hands ;  but  there  is  a 
great  deal  to  be  said  against  his  not  having  told  the  doctor, 
openly,  what  he  was  doing ;  or  against  his  not  having  said 
to  him  :  "  My  dear  doctor,"  or,  ^^  My  stupid  doctor,  I  believe 
your  '  medicine'  will  do  me  no  good.  You  had  better  stay 
at  home,  and  not  trouble  yourself  any  more  about  my  case." 
Of  course,  he  would  not  then  have  the  pleasure  of  scoffing 
afterward  at  the  doctor,  and  of  telling  him,  either  directly  or 
indirectly,  ^^  It  was  not  your  treatment  that  did  it."  Besides, 
the  scapegoat  would  be  wanting  on  whose  shoulders  to  lay 
the  blame,  should  the  disease  take  a  fatal  turn.  For  it  is 
by  no  means  of  rare  occurrence  that  the  sick  person  dies 
whilst  under,  as  it  is  pretended,  the  treatment  of  the  phy- 
sician, but  when  in  reality  he  himself  or  his  attendants  have 
^^  cured"  him  to  death.  Were  it  necessary,  I  could  relate 
here  quite  a  number  of  illustrative  examples  j  some  not  a 
little  amusing,  and  some  very  distressing. 

A  third  principle  requisite  for  efficient  nursing  is  the 
proper  psychical  disposition  of  the  attendants.     Patience, 


NURSING  THE   SICK.  235 

self-control,  self-denial,  and  an  obliging,  kind,  and  cheer- 
ful disposition,  should  be  possessed  by  them.  Kind  and 
sympathetic  behavior,  cheerful  conversation,  avoiding  all 
disagreeable  topics,  and  consoling  words,  will  attract  the 
good-will  and  confidence  of  the  invalid,  and  alleviate  his 
sufferings.  The  nurse  should  oblige  the  invalid  in  all  his 
wishes,  and  supply  his' wants  with  amiableness  and  gentle- 
ness of  manner,  provided,  of  course,  that  these  wishes  are 
not  against  his  real  welfare.  He  should  patiently  bear  the 
complaints  of  the  patient ;  he  should  not  let  his  temper  be 
easily  ruffled  by  his  irritability  and  obstinacy,  nor  become 
vexed  at  the  incessant  interruptions  about  trifling  things 
which  the  invalid  may  want  done  ;  he  must  even  bear,  with 
cheerful  equanimity,  impatience,  rudeness,  and  want  of  ap- 
preciation of  his  services,  on  the  part  of  the  patient.  He 
must  manifest  no  repugnance  toward  the  most  demeaning 
and  humiliating  offices. 

I  know  how  difficult  it  often  is  to  maintain  the  right 
disposition  and  proper  temper  in  the  sick-room.  The 
cares  and  troubles  of  daily  life,  the  sorrow  and  anxiety 
attending  the  sickness  of  dear  relations,  may  often  require 
heroic  efforts  to  control  the  feelings  in  the  presence  of  the 
invalid.  He,  by  all  means,  should  know  as  little  as  pos- 
sible of  this  common  grief.  He  has  an  affliction  of  his 
own — his  own  pains  and  anxieties ;  and  it  is  common 
philanthropy,  as  well  as  duty,  on  the  part  of  relatives,  to 
alleviate  his  burden  as  much  as  possible,  and  to  ward  off 
his  share  of  the  common  hardships  of  life. 

After  this  introduction,  I  proceed  to  the  consideration  of 
some  of  the  points  of  special  importance  in  the  proper 
regulation  of  the  sick-room. 


236  THE    SICK-ROOM. 

L—THE  SICK-ROOM. 

It  is  an  abuse  to  have  the  meaner  and  smaller  rooms  of 
the  house  set  apart  for  sleeping  apartments,  and  every 
possible  opposition  should  be  offered  to  it,  at  least  in  cases 
of  serious  disease.  The  sick-room  should  be  the  best  room 
in  the  dwelling.  It  should  be  large  enough  to  allow  the 
patient  35-50  cubic  meters  (1100-1600  cubic  feet)  of  air- 
room.  It  should  be  airy  and  bright;  if  possible,  on  the 
sun-side,  and  away  from  noisy  streets  and  courts.  There 
should  never  be  any  unnecessary  furniture,  clothes,  etc.,  in 
this  apartment,  nor  anything,  not  absolutely  necessary, 
which  is  calculated  to  present  an  obstacle  to  keeping  it  in 
a  condition  of  complete  order  and  cleanliness.  Night-chair, 
bed-pan,  bed-blankets,  dirty  linen,  and  soiled  bandages, 
ought  never  to  be  allowed  to  remain  in  the  sick-room,  but 
they  must  be  removed  to  one  adjoining. 

To  keep  the  air  pure  is  always  of  primary  importance. 
For  this  reason,  all  excrements,  strong-smelling  essences, 
flowers,  and  fumigations,  must  be  removed ;  above  all, 
frequent  ventilation  must  be  resorted  to.  This  is  done 
best  by  opening  windows  in  an  adjoining  room,  because 
the  invalid  is  thus  safe  from  currents  of  air.  If  this 
advantage  is  not  to  be  had,  the  windows  in  the  sick-room 
itself  may  be  opened,  without  any  apprehension,  if  the 
patient  is  only  protected  from  draught,  either  by  a  screen, 
or  by  drawing  the  quilt  or  bed-covering  over  his  head,  or 
by  holding  it  high  up.  Only  in  inclement  weather,  or 
while  the  patient  is  bathing,  or  perspiring  copiously,  or 
while  bandages  are  being  put  on,  the  windows  should  not 
be  kept  open.  The  temperature  of  the  sick-room  should 
be  the  same  as  is  agreeable  to  healthy  persons,  about  15° 
R.     In  pulmonary  diseases,  and  if  the  patient  is  old,  it  may 


THE    SICK-ROOM.  237 

be  raised  to  16-17^  R.  ;  but  when  tlie  disease  Is  febrile 
(tj'plius,  small-pox,  scarlet),  the  temperature  of  13-14°  R. 
is  sufficient  whilst  the  fever  is  at  its  height.  If  the  room 
is  heated  by  a  stove,  care  must  be  taken  that  no  coal-gas 
escape,  and  that  the  bed  be  not  too  near  the  stove. 

The  bed  of  the  patient  should  never  stand  near  the 
window.  The  best  way  is  to  place  it  with  the  head-end 
against  the  wall,  so  that  there  is  easy  access  from  all  sides. 
If  it  has  to  stand  parallel  to  the  wall,  it  should,  however, 
be  removed  from  the  same,  one  and  a  half  to  three  feet. 

Means  should  be  taken,  especially  during  pulmonary 
complaints,  to  keep  the  air  moist ;  either  by  placing  a  wide, 
flat  dish  or  basin  in  the  room  containing  water,  or  sprinkling 
the  floor,  from  time  to  time,  with  fresh  water,  or  with  a 
mixture  of  vinegar,  or  white  wine  and  water.  The  latter 
mode  is  especially  agreeable  in  summer.  But  the  floor 
must  be  kept  from  being  wetted,  especially  if  the  boards 
are  not  oiled. 

The  light  of  the  sick  room  : — Full,  glaring  sunlight 
should  not  be  allowed  to  strike  directly  on  the  bed,  and  the 
admission  of  full  daylight  should  be  moderated  by  curtains. 
It  is  not,  however,  intended  by  this  that  the  windows  should 
be  covered  either  with  heavy  or  dark  curtains,  or  with 
shutters,  so  as  to  darken  the  room.  Darkening  is  only 
serviceable  in  some  few  cases  ;  for  instance,  when  delirium 
is  present,  or  for  some  aiFections  of  the  eye.  During  night, 
the  room  is  lighted  best  by  a  piece  of  waxen  wick  fastened 
upon  a  small  tin-frame,  and  floating  on  the  oil  upon  a  cork- 
piece.  If  more  light  is  needed,  large  lamps  must  be  avoided 
(especially  petroleum  lamps)  •,  wax  or  stearine  candles  may 
be  used.  Lamps,  as  well  as  tallow-candles,  give  out  too 
much  smoke. 

Avoid  all  unnecessary  noise  in  the  sick-room.    Arranging 


238  THE   SICK-BED. 

of  furniture,  cleaning  the  room,  opening  and  closing  of  doors, 
treading  with  a  heavy  foot,  or  high  heels,  or  creaking 
shoes, — all  this  may  be,  for  the  morbidly  susceptible  ner- 
vous system  of  the  invalid,  so  many  shocks  which  can  be 
easily  spared  him,  with  a  little  care  on  the  part  of  the  attend- 
ants. Again,  too  long  or  too  loud  conversations  in  the  sick- 
room should  not  be  allowed  j  still  less,  those  abominable 
whisxjerings.  The  invalid  does  hear  them,  although  often 
he  cannot  understand  them  :  and  thus  alarm  is  excited  in 
his  mind.  Things  that  the  patient  ought  not  to  hear,  should 
not  be  spoken  of  in  the  sick-room :  either  silence  should 
be  kept  about  them,  or  the  conversation  should  be  carried 
on  in  another  room. 


II.— THE  SICK-BED. 

If  a  choice  can  be  had  of  bed-materials,  it  may  be  con- 
sidered that  iron  bedsteads  are  more  airy — freer,  too,  from 
vermin ;  that  wooden  ones  keep  the  bed  warmer.  The  bed 
itself  should  consist  of  a  mattress  of  horse-hair  or  sea-grass. 
A  well-filled  straw-bag,  with  a  blanket  spread  over  it, 
makes  a  good  bed,  and  is  often  the  only  one  to  be  had  in 
the  country,  and  by  poor  people.  Feather-beds  engender 
too  much  heat,  and  cause  bed-sores :  they  should  be  used 
only  for  very  old  and  feeble  people,  and  perhaps  for  those 
who  have  been  accustomed  to  them  from  childhood.  Pillows 
may  be  filled  with  feathers ;  only  in  affections  of  the  head, 
pillows  of  horse-hair  should  be  preferred.  For  covering, 
blankets  are  the  best  material :  feather-pillows  and  beds 
are  loo  warm.  In  winter,  any  want  of  heat  should  rather 
be  supplied  by  a  moderate  heating  of  the  room  ;  and  the  bed 
may  be  warmed  by  hot  bottles,  warm  stones,  etc.,  before 
changing. 


THE    SICK-BED.  289 

Curtains  should  be  discarded  from  the  sick-bed^  because 
they  hinder  the  change  of  air. 

It  is  a  very  good  thing  to  attach  a  rope  or  a  girth, 
either  to  the  ceiling,  or  to  the  foot-end  of  the  bed,  with  a 
handle,  in  order  to  assist  feeble  patients  to  get  into  an  erect 
position. 

When  the  bed  requires  to  be  made,  or  the  bed-linen  to 
be  changed,  the  patient,  in  serious  diseases,  should  be 
moved  to  another  bed  or  sofa,  or  to  an  upholstered  chair, 
with  great  care,  and  he  should  be  well  covered.  If  there 
is  only  one  bed,  and  no  other  furniture  near,  a  straw  bag 
may,  anyhow,  be  easily  procured. 

In  changing  the  dress  great  precaution  should  be  taken. 
The  linen  should  be  well  dried  and  warmed.  The  body 
of  the  patient  should  never  be  entirely  stripped,  but  only 
the  smallest  part  possible,  and  for  the  shortest  time  possible. 
If  the  arm,  for  instance,  is  the  part  affected,  the  articles 
uf  dress  should,  of  course,  first  be  removed  from  it ;  because, 
otherwise,  there  would  be  too  much  forcible  bending  and 
stretching  of  the  same.  If  a  diseased  limb,  such  as  the 
arm,  cannot  be  moved  at  all,  the  shirt-sleeve  must  be  cut 
open  to  the  collar  and  fixed  with  strings. 

Daily  washing  is  of  great  benefit  to  the  patient.  This 
might  not  be  possible  daily  with  all  patients,  but  it  should 
be  the  rule  ;  and  the  same  will  apply  with  regard  to  comb- 
ing the  hair.  This  is  not  done  in  diseases  of  the  brain  only, 
and  in  typhus-fever.  When  washing,  one  part  should 
always  be  finished  and  dried  with  a  warmed,  or  at  least  not 
cold,  towel,  before  another  part  is  made  wet.  Finally,  the 
patient  must  be  made  to  cleanse  his  mouth  often,  and,  if 
he  is  too  feeble  himself,  it  should  be  washed  by  others  with 
fresh  water. 

If  there  is  involuntary  discharge  of  stool  and  urine,  some 


240  BED-SORES. 

water-proof  material  (oil  or  caoutchouc  cloth)  must  be 
placed  under  the  under-sheet,  and  over  it  may  be  laid  a 
blanket  folded  up  several  times.  Of  course,  such  invalids 
should  be  washed  after  each  such  accident. 

During  diseases  of  longer  duration,  especially  of  old 
people  J  and  those  suffering  from  protracted  or  malignant 
feverS;  there  often  occur  the  so-called : — 


III.— BED-SORES. 

The  best  and  easiest  remedy  is,  to  prevent  their  occur- 
rence. A  frequent  change  of  position  and  of  the  sheets, 
as  well  as  a  frequent  inspection  and  washing  of  the  threat- 
ened parts,  wall  generally  be  effective  in  this  direction. 
A  second  precaution  is,  not  to  allow  the  shirt,  or  sheet,  or 
blanket,  to  lie  in  folds  under  the  patient's  body.  For  this 
reason,  the  under-sheet  should  be  pinned  to  the  mattress 
smoothly,  especially  in  the  case  of  restless  patients,  and 
of  such  as  sink  in  the  bed  on  account  of  unconsciousness 
and  feebleness.  To  prevent  the  sinking  and  bed-sores,  it 
is  very  serviceable  to  lay  the  patient  on  a  well-tanned 
hairy  skin  (the  tail-end  to  the  upper-end  of  the  bed),  or 
on  india-rubber  rings  filled  with  air  or  water  of  26-28^  R., 
or  on  air-  or  water-pillows,  or  on  complete  water-beds. 
Instead  of  india-rubber  rings,  a  contrivance  may  be  made 
by  wrapping  linen  or  soft  leather  around  a  ring  of  straw, 
and  placing  it  under  the  body  in  such  a  manner  that  the 
threatened,  or  already  sloughy,  part  of  the  skin  come  in  the 
opening  of  the  ring,  and  be  thus  protected  from  pressure. 
The  pillows  at  the  head  should  not  be  too  high,  to  avoid 
sinking  in  bed. 

Every  day,  and  repeatedly  during  the  day,  if  the  patient 


BED-SORES.  241 

be  unconscious  or  suffering  from  serious  fevers,  those  parts 
of  the  body  on  which  such  excoriations  more  easily  appear, 
must  be  examined.  These  are  :  the  haunches,  or  the  lower 
part  of  the  back,  the  shoulder-blades  and  the  heels.  If 
red,  painful,  swollen  places  appear  on  the  skin,  they  should 
be  washed  with  water,  brandy,  vinegar,  wine  ;  leraon-slicesj 
white  of  egg,  or  dressings  of  lead-water,  should  be  applied; 
A  mixture  of  one  well- beaten  egg  to  half  a-pint  of  water  is 
very  good  for  these  washes. 

Even  mere  red  spots  should  be  pointed  out  to  the  phy- 
sician at  his  next  call ;  and  the  more  so  because  there  is  a 
malignant  class  of  bed-sores  in  which  bluish-red,  or  bluish- 
green,  or  black  excoriations  appear,  generally  with  blisters 
covered  with  bright,  or  dirty-colored,  and  often  putrid, 
matter.  Dressings  of  good  wine,  camphor-wine,  with  or 
without  lead- water,  of  solution  of  chloride  of  lime  (half-an- 
ounce  to  a  pint  of  water),  or  of  solution  of  carbolic  acid  (four 
scruples  to  a  pint  of  water,  or  olive-  or  linseed-oil)  must 
be  applied.  Also  dressings  of  tannic  lead  are  of  good  service  j 
which  may  be  easily  made,  by  adding  two  parts  of  liquor 
Bubacetate  of  iron  to  a  filtered  decoction  of  two  parts  of  oak- 
bark  with  eight  parts  of  water.  The  precipitate  is  collected 
by  straining  the  water  through  a  fine  handkerchief,  and  is 
then  used  for  poultices. 

In  order  to  purify  the  air  and  to  destroy  bad  odors, 
as  well  as  to  arrest  danger  of  contagion  and  to  destroy  the 
odor  and  poison  of  corpses,  different  so-called  disinfecting 
agents  are  employed.  Above  all,  importance  has  been 
attached  to : — 


11 


242  FUMIGATIONS. 

IV.— -FUMIGATIONS. 

Unprofessional  persons  cannot  do  much  herein  without 
the  special  directions  of  the  physician.  Some  of  the  sub- 
stances most  commonly  employed  by  unprofessional  persons, 
such  as  pastils,  camphor,  etc.,  only  cover  the  offensive 
smells,  but  do  not  destroy  them ;  they  only  intensify  the 
impurity  of  the  air,  and  they  should  not  he  used.  Another 
class  of  fumigations,  for  instance  the  nitric  and  sulphuric 
fumigations,  are  intolerable  to  human  beings. 

The  best  fumigations,  in  all  cases,  are  those  of  chlorine, 
which  are  used  in  different  strengths,^  as  the  case  may 
require. 

Apart  from  a  special  prescription,  the  following  one 
should  be  employed  : — 

1.  In  the  sick-room.  If  here  a  disinfecting  fumigation 
is  necessary,  place  a  pailful  of  water  in  the  corner  most 
remote  from  the  invalid;  add  10-15  ounces  of  chloride 
of  lime,  and  stir  the  mixture  from  time  to  time  with  a 
wooden  stick.  In  addition,  linen  rags  dipped  in  a  solution 
of  chloride  of  lime  may  be  suspended  from  a  line. 

It  is  pleasant  to  the  olfactory  organs,  and  is  not,  at  aU 
events,  corrupting  to  the  air,  to  evaporate  vinegar  or  aro- 
matic vinegar,  either  by  sprinkling  the  floor,  or  by  pouring 
it  on  hot  stones  or  iron  plates,  or  by  simmering  it  over  an 
alcohol-lamp.  But  hereby  only  the  smell  is  improved ;  the 
infecting  matter  is  not  destroyed,  and  the  air  is  not  actually 
purified. 

2.  Fumigations  of  corridors  may  be  a  little  stronger. 
In  different  spots,  place  plates  or  earthen  dishes,  each  con- 
taining 14-3J  ounces  of  chloride  of  lime,  and  sprinkle 
them  from  time  to  time  with  vinegar,  or  diluted  sulphuric 
or  muriatic  acid. 


FUMIGATIONS.  243 

3.  After  the  death  of  the  patient j  fumigations,  such  as 
those  described  under  No.  2,  may  be  used,  or  even  the  still 
stronger  so-called  Gujton  Morveau  fumigation.  But  this 
strong  chlorine  fumigation  is  not  only  intolerable  and  even 
dangerous  to  men  and  animals,  but  it  affects,  also,  metals, 
and  destroys  the  color  of  plants.  As  it  is  generally  intended, 
at  the  same  time,  to  disinfect  and  to  purify  furniture,  beds, 
wearing-apparel,  etc.,  all  these  things  must  be  placed  or 
suspended  in  such  a  manner  that  their  broadest  sides  are 
exposed  to  the  fumigation  :  for  instance,  mattresses  are  put 
on  the  edges,  clothes  are  suspended  from  frames. 

The  Guyton-Morveau  fumigation  is  obtained  in  this 
manner  :  on  a  dry  mixture,  of  one  part  black  oxide  of  man- 
ganese, and  three  parts  common  salt,  pour,  little  by  little,  a 
mixture  of  two  parts  concentrated  sulphuric  acid  (vitriol) 
and  two  parts  water.*  The  whole  is  placed,  either  over  a 
night-light,  or  into  hot  sand.  For  a  room  of  35  cubic  metres, 
it  suffices  to  take  7  drachms  salt,  2  drachms  and  2  scruples 
brown-stone,  of  sulphuric  acid  and  water,  half  an  ounce  (a 
tablespoonful)  each.  After  the  mixture  is  ready,  close  doors 
and  windows  as  tightly  as  possible ;  then  allow  the  vapors 
to  take  effect  for  some  hours ;  ventilate  well  afterward. 

A  simple  way  of  disinfecting  linen  is  to  soak  it  in  a 
solution  of  chloride  of  lime  (one  ounce  to  a  quart  of  water), 
before  washing. 

Hands  and  face  are  disinfected  by  washing  in  a  solution 
of  carbolic  acid  (16  grains  to  a  half-pint  of  water),  or  of  kali 
hypermanganicum  (16  grains  to  a  pint  of  water).  The 
latter  may  also  be  used  for  cleansing  the  mouth  after 
dealing  with  contagious  diseases,  corpses,  or  decomposing 

*  The  mixture  of  sulphuric  acid  and  water  should  be  made  by  the 
druggist  ;  or  else  pour  the  sulphuric  acid  very  slowly  into  the  water, 
never  vice  versa,  because  then  the  mixture  explodes,  and  may  cause  grave 
injuries. 


244  ARTICLES    OF   DIET   FOR   THE    SICK-ROOM. 

corpses.  On  a  corpse  of  very  offensive  smell  scatter  some 
chloride  of  lime,  or  put  on  some  flaps  of  linen,  cloth,  flannel, 
etc.,  soaked  in  a  solution  thereof. 

v.— ARTICLES  OF  DIET  FOR  THE  SICK-ROOM. 

A  detailed  regulation  of  both  the  quantity  and  quality 
of  the  food  will  be  given  by  the  physician,  at  least  in 
serious  diseases.  The  attendants  should  then  strictly  con- 
form to  it.  Negligence  and  insubordination  in  this  respect 
have  often  been  the  source  of  relapse  and  death.  Mistaken 
kindness  of  gentlemen  and  ladies  Bountiful,  who  think 
themselves  bound  to  carry  some  "  good  things  "  to  the  pa- 
tient, is  frequently  productive  of  serious  mischief,  especially 
in  the  case  of  little  children. 

Food  and  drink  must  neither  be  given  too  warm  nor 
too  cold,  except  by  the  special  order  of  the  medical 
attendant. 

While  eating,  the  patient  should  be  raised  in  bed,  if 
possible ;  his  back  must  then  be  supported  either  with 
the  hand  or  with  pillows.  It  is  better  to  put  the  dishes  on 
a  board  which  is  placed  on  the  bed  in  front  of  the  invalid, 
than  to  have  them  on  a  table  near  the  bed :  an  arrangement 
which  often  causes  much  inconvenience.  Very  feeble 
persons  must  be  fed  very  slowly.  While  drinking,  the 
patient's  head  should  be  raised )  the  vessel  to  drink  from 
should  not  be  too  full ;  sometimes  it  is  advisable  to  use  a 
spoon  for  administering  drink.  Care  should  be  taken  not 
to  give  to  patients  who  are  unconscious  or  delirious, 
drinking-vessels  which  they  might  bite.  Thus  injury  to 
the  mouth  will  be  prevented.  Some  drinks,  as,  for  instance, 
acidulated  lemonades,  etc.,  must  not  be  allowed  to  remain 
too  long  ia  vessels  ©f  metal. 


•ARTICLES   OF   DIET  FOR  THE   SICK-ROOM.  245 

As  not  unfrequently,  especially  in  chronic  diseases,  the 
choice  of  food  and  drink  is  left  to  the  patient  himself  or 
his  nurses,  it  may  be  useful  to  offer  a  few  hints  as  to  what 
foods  are  more  or  less  easily  digested,  and  what  are  the 
best  beverages. 

1. — Animal  Food, 

Of  easy  digestion  are :  young  pigeons  and  chickens, 
veal,  roasted  meat  of  young  oxen,  scraped  raw  ham  and 
corned  beef,  the  lean  of  mutton,  venison,  game,  except  that 
of  a  winged  kind,  lightly  boiled  or  raw  eggs.  Also,  milk 
in  not  too  large  quantities,  whey,  buttermilk,  and  curd 
with  sugar  and  cinnamon,  but  not  too  cold.  Fishes  of  easy 
digestion  are :  cooked  turbot,  haddock,  pike,  trout,  perch, 
fresh  herring ;  oysters,  three  to  six  at  a  time. 

Hard  to  digest  are:  cooked  beef,  pork,  all  sausages, 
duck,  goose,  turkey,  winged  game,  fried  liver,  mince-pies, 
hard-boiled  eggs,  beaten  egg,  all  cheese.  Of  fishes :  all 
fried  fish,  carp,  salmon,  eel,  and  most  sea-fishes :  lobsters, 
crabs,  prawns,  scallops,  and  mussels,  are  not  of  easy 
dio:estion. 


2. — Vegetable  Food, 

Easily  digestible  :  young  carrots  and  peas,  asparagus, 
spinach,  artichokes,  cauliflower,  boiled  and  mashed  potatoes, 
rice,  sago,  peeled-barley,  groats,  wheaten  bread. 

Hard  to  digest :  all  of  the  cabbage  tribe  (more  digestible, 
perhaps,  sauerkrout),  white  turnips,  onions,  cucumbers, 
mushrooms,  truffles,  pastry  of  every  kind,  farinaceous  food, 
rye-bread ;  salads,  the  very  bitter  ones  excepted. 


246     ARTICLES  OF  DIET  FOR  THE  SICK-ROO.\r. 

Fruit  is  in  general  more  wholesome  if  cooked.  Raw, 
of  easy  digestion,  are,  if  quite  ripe:  strawberries,  rasp- 
berries, currants,  apricots,  sour  cherries,  grapes,  apples 
and  oranges.  Of  hard  digestion :  pears,  peaches,  plums, 
pine-apples ;  oily  fruits,  such  as  nuts,  almonds.  Also  all 
fruit  preserved  with  sugar  or  vinegar. 

3. — Beverages. 

Cooling  drinks :  water,  ice-water,  seltzer,  mineral  waters, 
lemonades  with  sugar  and  juices  (of  lemons,  oranges,*  rasp- 
berry, etc.),  so-called  fruit-water  (baked  apples,  pears, 
plums,  cooked  in  water). 

MueilaginouSy  nutritive^  stimulant  drinks  :  milk,  milk  of 
almonds  (beat  1-1 J  ounces  of  sweet  almonds  with  a  little 
water,  pour  a  pint  of  water  into  the  paste,  which  should  be 
constantly  stirred,  filter,  and  add  a  small  proportion  of  re- 
fined sugar),  rice-water,  barley-gruel  (2-3  ounces  of  pearl- 
barley  cooked  with  a  quart  of  water),  oatmeal-gruel  (one 
tablespoonful  of  oatmeal  cooked  in  a  quart  of  water),  arrow- 
root-mucilage (one  teaspoonful  cooked  in  a  quart  of  water, 
add  sugar  and  cinnamon),  toast-water  (7  ounces  crackers 
or  rye-bread  boiled  in  quart  of  water  and  strained),  to  which 
2—3  table  spoonfuls  of  lemon-juice  may  be  added,  or  one 
tablespoonful  of  cinnamon  water,  or  one  half-pint  of  rhine- 
or  red-wine  and  sugar ;  egg-wine  (one  well-beaten  eggy 
3-4  teaspoonfuls  of  sugar  to  a  pint  of  water,  with  or  with- 
out wine)  J  good  bouillon,  beef- tea  (take  half-a- pound  of 
good  rump-steak,  cut  into  thin  slices,  pour  upon  the  whole 
about  one  quart  of  cold  water,  let  it  draw  for  two  hours  and 

*  The  lemons  and  oranges  are  cut  a  little,  and  then  Pome  of  \he  juice  is 
squeezed  into  the  water.  It  is  a  wronp^  practice  to  put  slices  of  the  fi  iiit^ 
with  the  peel  attached,  into  tlie  water,  because  the  essential  oil  thus  solved 
from  the  peel  may  easily  cause  headache. 


ADMINISTRATION   OF  MEDICINES.  247 

simmer  for  three  to  four  hours  over  a  slow  fire — skim  and 
strain)  ;  water  with  half  or  fourth  part  wine,  light  beer,  pure 
wine,  as  the  physician  directs. 

If  wine  is  allowed,  but  cannot  be  had,  this  substitute 
may  be  used :  take  one-fourth  pint  good  rye-whiskey  or 
one  ounce  of  rectified  wine-spirits,  add  a  quart  of  water 
and  1 J-2  ounces  syrup  or  sugar ;  to  each  quart  of  this 
mixture  the  yolk  of  two  eggs  well  stirred,  with  sugar,  may- 
be added. 


VI.— ADMINISTRATION  OF  MEDICINES. 

Nothing  is  of  a  trivial  nature  in  the  management  of  the 
sick-room.  A  few  rules,  therefore,  in  reference  to  ad- 
ministering medicines  may  be  given  here,  although  they 
appear  to  some  unimportant  and  clear  in  themselves. 

The  principal  thing  is  to  administer  the  medicine  ex- 
actly in  the  quantity  and  at  the  time  ordered-  The  label, 
therefore,  with  the  direction  for  administering,  should  not 
be  torn  ofi".     This  may  be  the  cause  of  much  mischief. 

There  should  be  an  interval,  of  half-an-hour  at  least,  be- 
tween the  taking  of  medicine  and  a  meal,  unless,  as  is  some- 
times the  case,  it  is  ordered  to  be  taken  at  meals. 

The  medicine  bottle  must  be  kept  well  corked  f  not  too 
near  the  stove,  nor  exposed  to  the  direct  rays  of  the  sun. 

Medicines  for  external  application  should  be  kept  apart 
from  those  for  internal  use.  Without  this  precaution,  there 
might  be  much  mischief  done.  The  spoon  (china  or  so- 
called  medical  spoons  are  the  best)  should  be  put  in  water, 
or  well  cleansed,  every  time  after  it  has  been  used.  While 
administering,  the  spoon  should  be  held  at  the  lower  end 
of  the  handle  :  there  is  thus  less  danger  of  spilling. 


248  ADMINISTRATION    OF   MEDICINES. 

When  counting  drops.,  the  neck  of  the  bottle  should  be 
moistened  to  the  brim,  in  order  to  prevent  a  sudden  rush  of 
the  fluid.  As  most  medicines  in  drops  are  rather  irritant, 
the  dose,  should  be  poured  into  water,  sugar -water,  or  on 
sugar. 

Pills,  a  very  good  from  for  medicines  of  bad  taste,  cannot 
be  taken  dry  by  some.  In  this  case  they  should  be  given 
with  half-a-spoonful  of  water,  or  they  should  be  wrapped 
up  in  a  morsel  of  bread,  or  in  a  plum  from  which  the  ker- 
nel has  been  removed. 

Powders  are  administered  either  dry  on  the  tongue, 
giving  a  mouthful  of  water  afterward,  or  they  are  stirred 
in  a  spoon  with  a  little  water,  or  they  are  wrapped  in  a 
wafer.  If  stirred  in  water,  care  should  be  taken  that  the 
patient  takes  the  whole.  For,  as  the  powders  generally  do 
not  dissolve  entirely  in  water,  the  principal  part  remains 
often  in  the  spoon,  which  should  be  collected  by  another 
stirring  and  then  given.  If  powders,  any  for  instance  of  bad 
smell  or  taste,  are  to  be  wrapped  up  in  wafers,  dip  a  suffi- 
ciently large  piece  of  the  wafer  into  water,  place  it  on  a 
tablespoon,  pour  the  powder  on  it,  and  then  fold  the  edges 
together  over  the  powder  so  as  to  form  a  small  round  ball. 
This  is  placed  at  the  top  of  the  spoon,  and  thus  given  to 
the  patient,  who  takes  a  mouthful  of  water  after  it. 

If  the  patient  has  to  take  an  emetiCj  he  should  not  shortly 
before  eat  any  solid  food  :  everything  which  causes  pres- 
sure must  be  loosened  or  put  off.  Trusses  only  must  not 
be  loosened,  but  rather  fastened  as  well  as  possible.  When 
retching  comes  on,  and  not  before,  moderate  draughts  of 
tepid  chamomile-tea,  or  warm  water,  or  water  and  butter, 
etc.,  may  be  given  to  promote  the  vomiting.  Generally, 
there  are  two  to  four  vomitings  caused  by  the  emetic,  which 
are  sufficient.  But  if  vomiting  continues,  or  if  the  sensatioa 


LOCAL  APPLICATIONS.  249 

of  nausea  is  still  very  strong,  a  cup  of  black  coffee  or  a 
fermenting  powder  may  be  given,  and  a  poultice  of  mustard- 
meal  or  the  like  may  be  applied  to  the  pit  of  the  stomach. 
Emetics  should  never  be  given  without  the  advice  of 
the  medical  attendant.  If  an  emetic  has  been  ordered,  but 
has  not  yet  been  taken,  and  there  is  spontaneous  vomiting, 
diarrhoea,  coughing  of  blood,  vomiting  of  blood,  cramps  or 
violent  griping,  its  administration  ought  to  be  suspended 
till  the  physician  has  been  again  consulted. 

VII.— LOCAL  (TOPICAL)  APPLICATIONS. 

Embrocations,  plasters,  salves.  In  case  of  embrocations, 
which  are  done  either  with  the  naked  hand  or  with  a  piece 
of  wool,  it  is  important  to  keep  up  a  constant  friction,  but 
without  using  too  much  pressure,  lest  the  epidermis  be 
rubbed  off,  and  the  patient  caused  more  pain  than  neces- 
sary. The  patient  must  not  be  uncovered  more  than  is 
absolutely  necessary  :  on  the  one  hand,  to  spare  his  modesty, 
and,  on  the  other,  to  avoid  exposure  to  cold.  Irritant 
salves,  and  especially  mercurial  ointments,  are  rubbed  in 
either  with  an  old  kid-glove  or  with  a  soft  dry  pig-bladder. 
This  will  prevent  soreness  of  the  fingers  ;  moreover,  with- 
out this  precaution,  a  flow  of  saliva  might  be  caused  by 
the  mercury.  After  every  rubbing,  even  with  the  most 
harmless  remedies,  the  hands  should  be  well  washed. 
Plasters  and  salves  should  not  be  spread  too  thickly  over 
the  linen ;  otherwise  the  skin  is  unnecessarily  soiled.  If 
a  wound  is  dressed  with  salves,  the  wound  itself  and  the 
neighboring  parts  must  be  well  cleared  of  pus  and  old 
salve,  before  another  dressing  is  applied.  The  best  way 
to  remove  the  salve  is  to  wash  the  skin  with  oil ;  the  wound 


250  .       LOCAL  APPLICATIONS. 

ilself  is  cleaned  by  syringing  and  rinsing  it  with  water, 
charaomile-tea,  or  a  disinfectant  solution  prescribed  by  the 
physician.  Plasters,  especially  adhesive,  that  do  not  ad- 
here of  themselves,  are  held  for  some  seconds  to  the  warm 
stove :  the  often-practised  method  of  breathing  on  them 
is  improper,  because  it  moistens  the  plaster.  Salves  must 
be  protected  from  dust,  as  well  as  from  decomposition 
through  light :  the  vessel,  therefore,  should  be  well  closed 
after  each  use. 

PouUiceSj  cataplasms.  The  principal  kinds  are :  the 
warm  emollient,  and  the  cooling  cataplasms.  In  the  first, 
warmth  and  moisture  are  the  main  thing.  The  temperature 
of  the  blood  suffices  :  they  are  tested  with  the  cheek,  nose, 
or  the  back  of  the  hand.  They  have  to  be  renewed  when 
the  patient  feels  a  decrease  of  heat,  generally  after  one-half 
to  one  hour.  If  they  are  to  be  kept  warm  and  moist  for  a 
longer  period,  they  should  be  covered  with  a  piece  of  water- 
proof material  (oil-cloth,  etc.),  somewhat  larger  than  the 
poultice  itself.  Poultices  soiled  by  pus,  blood,  etc.,  ought 
not  to  be  re-used,  but  must  be  replaced  by  fresh  ones. 
Emollient  warm  poultices  are  prepared  from  linseed-meal, 
wheat-bread,  groats,  starch-mealj  mucous  plants  (marsh- 
mallow)j  etc.,  and  are  wrapped  in  a  thin  cloth. 

For  cooling  cataplasms,  water  is  principally  used  in  cold 
compresses,  which  must  be  renewed  every  five  to  ten 
minutes.  It  is  very  good  to  let  cold  compresses  freeze.  For 
this  end,  place  them  on  a  ivooden  table,  put  on  them  a  flat 
metal  pan  filled  with  ice  and  some  coarse  common  ^alt :  they 
will  freeze  in  a  few  minutes.  Far  better  than  all  compresses, 
is  ice  or  snow  put  into  a  bladder  which  is  lined  with  fat 
inside,  or  into  an  india-rubber  pouch,  and  thus  applied. 
The  pouch  or  bladder  is  filled  with  pieces  of  ice  about  the 
size  of  a  nut,  and  some  water,  but  not  entirely,  because 


LOCAL  APPLICATIONS.  2ol 

Otherwise  it  will  not  so  well  adapt  itself  to  the  limb.  In- 
stead of  ice,  freezing  mixtures  may  be  put  into  the  pouch  ; 
for  instance,  sal-ammoniac  five  parts,  nitre  five  parts', 
Glauber's  salt  eight  parts,  water  sixteen  parts.  If  ice  or 
freezing  mixtures  are  used,  it  is  better  to  put  a  folded 
drj  pocket-handkerchief  between  the  pouch  and  the  skin, 
in  order  to  protect  the  latter  from  too  much  cold. 

So-called  stimulant  cataplasms  are  made  of  aromatic 
herbs — chamomile,  linden-blossoms,  peppermint  (fo-called 
herb-sacs).  If  moist  stimulant  cataplasms  are  wanted,  the 
same  herbs  may  be  used ;  or  add  to  any  one  of  the  above- 
named  cataplasms  some  spirits  of  ammonia  (40-60  drops), 
alcohol,  whiskey,  wine ;  or  compresses  of  warm  wine  or 
brandy  and  water  may  be  employed. 

Rubefacients  and  detergents.  Mustard  is  very  generally 
employed.  The  best  method  of  preparing  this  poultice  is 
simply  to  mix  2-5  ounces  of  fresh  mustard-seed  (pulver- 
ized) with  water  to  a  paste,  and  spread  it  thickly  on  a 
piece  of  linen  or  gauze.  Mustard  poultices  produce  inflam- 
mation in  from  five,  ten,  to  twenty  minutes,  according  to 
the  quality  of  the  mustard  and  the  sensibility  of  the  skin. 
Instead  of  it,  however,  a  paste  of  mashed  horseradish 
may  be  used,  or  a  piece  of  thick  blotting-paper  soaked 
with  mustard-spirits,  over  which  a  compress  is  placed ;  or 
simply  moistened  mustard-paper.  AVash  the  reddened  part 
of  the  skin  with  cream  or  milk,  and  put  a  piece  of  soft  lint 
over  it. 

Cantharides  is  the  irritating  substance  most  commonly 
employed  for  a  detergent.  The  plaster  is  made  of  various 
sizes,  from  that  of  a  fifty-cent  piece  to  that  of  a  plate, 
spread  to  about  the  thickness  of  the  blade  of  a  knife,  and 
provided  with  a  brim  of  adhesive  plaster.  It  must  lie  close 
to  the  skin  :  for  this  end,  a  bandage  may  be  placed  over 


252  LOCAL  APPLICATIONS. 

it,  but  not  too  tightly.  If  it  is  intended  to  redden  the  skin 
only,  the  plaster  is  left  on,  two  to  four  hours ;  to  draw  blis- 
•ters,  twelve  to  fifteen  hours.  If  suppuration  is  not  wanted, 
the  cuticle  is  cut  open  at  the  lower  end  without  removing 
it,  and  the  wound  is  dressed  with  lead-salve,  wax-salve,  oil, 
or  simply  with  lint  or  cotton.  For  suppuration,  the  cuticle 
is  cut  open  at  the  upper  end  and  removed,  and  the  wound 
is  dressed  with  irritating  salve.  As  the  latter  may  easily 
disturb  the  night's  rest,  it  is  better  to  dress  the  wound  at 
night  with  wax-salve.  In  order  to  procure  stronger  suppu- 
ration (fontanel),  peas,  small  balls  of  orris-root,  small  bitter 
oranges,  etc.,  are  fastened  over  the  wounded  place  by  ad- 
hesive plaster,  or  by  a  rather  tight  bandage. 

The  other  detergents,  tartar  emetic  ointment,  croton-oil,* 
ought  never  to  be  employed  without  special  medical  advice. 
Cauterizations  of  every  kind  can  be  applied  only  under  the 
direction  of  a  medical  man. 

Baths.  Foot-baths  should  be  taken  when  the  invalid  can 
go  to  bed  immediately  afterward.  The  temperature  should 
be  of  92-105°.  They  may  be  medicated  with  a  handful  of 
common  salt,  or  1  J-l|  ounces  mustard-meal.  If  not  other- 
wise ordered,  they  should  reach  only  to  the  ankles,  or  a 
little  above  them. 

General  baths  in  the  house  must,  of  course,  be  taken  in 
tubs,  which  are  best  made  of  zinc.  For  feeble  patients, 
place  a  thin  cushion,  for  instance  of  straw  or  hay,  or  a 
folded  blanket  or  cloth,  at  the  bottom  of  the  tub.  This  is 
filled  with  water  high  enough  to  have  the  shoulders  and 

*  The  same  applies  to  the  so-called  "  Lebenswecker  "  (Baunscheidtism, 
also  exantheiiiatical  remedies),  which  is  iiotliiiig  else  than  the  rubbing  of 
diluted  crolon  oil  into  the  small  wounds  made  by  the  needles  of  the  iiistiu- 
ment.  It  is  never  .«afe  to  take  a  measure  of  such  important  consequences 
without  medical  advice.  I  have  seen  several  cases  of  serious  erysipelas  result 
from  its  employmeot. 


LOCAL  APPLICATIONS.  253 

arms  of  t"he  patient  immersed  in  the  water.  The  tempera- 
ture *  is  determined  by  the  physician.  If  during  bathing 
the  water  become  too  cool,  an  addition  of  hot  water  may  be 
added  carefully  at  the  brim  of  the  tub.  While  the  invalid 
is  in  the  water,  he  should  not  remain  inactive,  but  apply 
friction  to  the  skin  ;  if  he  cannot  do  it  himself,  the  nurse 
must  do  it — of  course,  with  care.  The  duration  of  baths  is 
at  the  physician's  direction :  generally  it  is  ten  to  twenty 
minutes.  If  the  invalid  faints  while  in  the  water,  or  if  cramps 
or  hemorrhage  sets  in,  he  must  be  carefully  taken  out  of  the 
tub.  If  there  is  determination  of  blood  to  the  head,  as  is 
often  the  case,  accompanied  by  headache,  vertigo,  humming 
in  the  ear,  cold  water  may  be  poured  on  the  head,  or  it 
may  be  washed  with  cold  water  f  but  if  the  attacks  do  not 
cease,  but  increase,  the  patient  must  leave  the  tub. 

After  the  bath  the  body  should  be  folded  up  in  a  large, 
well-warmed  blanket,  and  should  be  dried  with  this  (best 
on  the  bed),  and  immediately  well  covered.  It  is  good  to 
give  to  the  patient,  soon  after,  a  little  warm  drink  or  soup : 
there  is  then  generally  inclination  to  healthy  sleep. 

Baths  are  generally  of  pure  water  :  ingredients  of  any 
kind  are  to  be  directed  by  the  physician ;  for  instance, 
baths  of  wheat-bran  (the  decoction  of  1-3  lbs.  wheat-bran 
in  a  pouch  cooked  in  five  quarts  of  water,  added -to  the 
bath) ;  malt-baths  (4-6  lbs  ;  for  a  child,  1-2  lbs.  malt  cooked 
in  five  to  twenty  quarts  of  water  for  half-an-hour  and 
strained :  one  to  two  quarts  of  beer-spice  may  do  as  a  sub- 
stitute), etc. 

*  The  following  arrangement  of  baths  according  to  temperature  is  likely 
to  be  useful:  the  cold  bath  60-70°,  the  temperate  75-85^,  the  tepid  85 -1)^-, 
the  warm  92-98°,  the  hot  98-112°.  The  temperature  should  be  te^teii 
with  the  thermometer  ;  otherwise,  not  by  the  hand,  but  with  a  part  of  the 
body  which  is  geneially  covered  with  clothes  and  more  susceptible,  for 
instance  the  elbow.  Neglect  of  this  precaution  (for  instance,  on  the  part  of 
midwives)  has  at  times  resulted  fatally.  New-boru  children  have  thereby 
been  Bcalded  to  death. 


254'  LOCAL   APPLICATIONS. 

Clysters  (enemata)  are  generally  applied  by  competent 
persons  (midwives,  etc.).  It  is  consequently  unnecessary 
to  speak  here  of  the  mode  of  application.  The  materials 
are  prescribed  generally  by  the  physician.  For  cases  of 
necessity,  it  will  do  to  know  that  in  purgative  clysters 
the  dose  for  adults  is  twelve  to  twenty  table  spoonfuls ; 
for  a  child,  according  to  its  age,  two  to  ten  tablespoonfuls. 
In  astringent  and  antispasmodic  clysters,  the  quantity 
should  be  about  one-half,  in  nutritive  one-third,  of  purgative 
ones.  The  temperature,  if  not  expressly  ordered  otherwise, 
92-950. 

Purgative  clysters  are  made  of  water  mixed  with  addi- 
tions of  one  to  two  tablespoonfuls  of  some  fat  oil  (castor- 
oil),  one  tablespoonful  of  sugar  or  honey,  one  to  two  tea- 
spoonfuls  of  common  salt,  about  three  drachms  white  soap, 
one  tablespoonful  wine- vinegar.  One  of  the  most  efficacious 
clysters,  for  instance  in  habitual  constipation,  hemorrhoids, 
is  that  of  pure  cold  water. 

Astringent  clysters  :  decoctions  of  oatmeal  gruel,  linseed, 
marsh-mallow  root,  gruel  of  starch-meal.  Ingredients,  for 
instance,  5-10  drops  opium-tincture,  are  prescribed  by  the 
physician. 

Antispasmodic  sedative  clysters  are  generally  made  in  the 
drug-store,  and  need  only  to  be  warmed  up.  Of  great  ser- 
vice, and  of  easy  preparation,  are  decoctions  of  chamomile 
blossoms,  valerian-root,  and  four  drachms  poppy-heads. 

Nutritious  clysters :  good  beef- tea  mixed  with  the  yolk 
of  eggs. 

Anthelmintic  clysters,  very  serviceable  for  small  intes- 
tinal worms,  are  generally  medicated.  Medical  aid  is  not 
often  sought  for  in  such  cases  ;  but  as  the  itching,  and  even 
the  crawling  of  the  worms  into  the  genitals  of  female 
children,  may  be  the  cause  of  the  practice  of  masturbation,  it 


LOCAL  APPLICATIONS.  255 

may  be  mentioned  here  that  a  decoction  of  six  to  eight  cut 
garlic-onions  in  six  to  twelve  tablespoonfuls  of  milk  is,  in 
the  form  of  a  clyster,  a  very  efficacious  means  of  removing 
these  intestinal  worms. 

Bloodletting,  Recourse  to  withdrawal,  of  blood  ought 
never  to  be  had  without  the  authority  of  the  medical 
attendant.  Besides,  the  application  of  cupping-glasses  and 
venesection  require  some  skill,  and  should  be  done  only 
by  competent  persons.  Leeches  are  applied  often  only  by 
the  attendants  of  the  patient. 

Leeches  should  be  bought  only  in  drug-stores,  because 
otherwise  there  is  no  certainty  of  obtaining  proper  and 
healthy  animals.  Only  the  German  or  the  Hungarian 
leeches  should  be  used.  Both  have  six  longitudinal  ferru- 
ginous stripes  on  the  back :  the  back  varies  from  blackish 
to  greyish-green.  The  under-parts  in  the  former  variety 
are  yellowish- green  with  black  spots  and  edgings  ;  in  the 
latter,  brownish-orange  without  spots,  but  with  two  black 
lateral  stripes.  The  horse-leech  has  no  stripes  on  the 
back,  and  must  not  be  used.  The  leech  is  sick,  if  the 
mouth-piece  (sharp  end)  is  soft,  if  the  animal  is  covered 
with  dirty  slime,  or  if  such  slime  is  seen  swimming  in  its 
neighborhood  in  the  water  j  finally,  if  it  is  not  active  in 
tepid,  or  even  in  fresh,  water,  but  is  lying  lazily  coiled 
up.  Sick  leeches  ought  not  be  used  5  generally,  they  do 
not  bite. 

Parts  to  which  leeches  should  not  be  applied  are  :  1.  Dis- 
eased parts  of  the  skin :  the  leeches  are  affixed  near  such 
places,  but  not  on  them.  2.  Parts  where  large  blood-vessels 
lie  directly  under  the  skin.  3.  Parts  where  the  epidermis 
is  too  thick — palm  of  the  hand,  heel.  4.  Parts  where  the 
healing  of  the  bite  might  be  distui'bed  by  flowing  pus  or 
putrid  matter. 


256  LOCAL  APPLICATIONS. 

The  parts  to  which  leeches  are  to  be  applied  must  be 
first  shaved,  if  necessary,  and  well  washed  with  a  little 
soap  and  warm  water,  and  lastly  well  dried. 

Immediately  before  the  leeches  are  used,  they  should 
be  put  for  a  few  minutes  into  tepid  water,  infusing  a  few 
drops  of  white  wine,  if  they  are  very  lazy.  Then  they 
are  taken  and  applied  with  the  freshly-washed  hand,  or 
with  a  soft  towel ;  or  a  better  method  is  to  place  them  in 
the  lid  of  a  pill-box,  or  under  a  small  glass,  which  is 
applied  to  the  affected  'parts.  In  order  to  affix  a  leech  to 
a  very  small  and  particular  spot,  for  instance  the  gum  or 
palate,  etc.,  the  best  way  is  to  use  a  narrow  tube,  called  a 
leech-glass.  The  leeches  must  not  be  let  loose  until  they 
have  bitten,  which  can  be  inferred  from  the  wave-like 
movements  of  the  neck,  and  from  the  circumstance  that 
the  head  forms  a  right  angle  with  the  body.  To  prevent 
the  danger  of  their  crawling  into  a  cavity  (gullet,  nose, 
anus),  a  thread  may  be  drawn  with  a  needle  through  the 
tail-end,  from  above,  downward  (not  from  side  to  side, 
because  their  blood-vessels  are  easily  hurt  thereby),  and 
they  may  be  held  by  this  thread. 

If  the  animals  do  not  bite,  scratch  the  skin  w^ith  the  point 
of  a  needle,  and  apply  the  leech  to  the  spot  moistened  with 
blood.  Or  they  may  be  made  to  bite,  by  moistening  the 
surface  to  which  they  are  to  be  applied  with  sugar  and 
w^ater,  or  milk. 

Leeches  should  never  be  forcibly  detached,  as  this  may 
cause  malignant  inflammations  and  violent  bleedings. 
They  should  be  permitted  to  drop  off  spontaneously.  If 
they  must  be  detached,  as  for  instance  when,  during  their 
application,  cramps  or  fainting  supervenes,  salt,  pepper, 
or  snuff  should  be  scattered  over  them,  after  which  they 
drop  off  immediately. 


LOCAL   APPLICATIONS.  ^57 

The  bleeding  may  be  kept  up  for  the  time  prescribed, 
by  fomenting  the  part  with  warm  dry  cloths,  or  by  a 
warm  pouliice,  or  by  sponges  soaked  with  warm  water. 
Cupping-glasses  should  never  be  applied  to  the  bitten 
spots  for  this  purpose. 

The  patient  must  not  be  left  alone  until  the  bleeding 
has  been  completely  stopped.  Children  must  be  watched, 
even  during  the  following  night,  on  account  of  the  danger 
of  their  bleeding  to  death.  The  bleeding  may  be  generally 
checked  by  the  application  of  a  piece  of  punk  or  scraped 
charjne;*  also  by  cobwebs,  glue,  pitch,  alum,  gunpowder, 
hydrated  sesquioxide  of  iron  (pressing  a  cork  moistened 
with  it,  or  a  piece  of  lint  soaked  in  it,  and  squeezed,  after- 
ward, on  the  wound).  Pressure  of  the  skin  into  folds  will 
often  arrest  the  bleeding.  In  more  obstinate  cases,  espe- 
cially of  children,  the  aid  of  a  physician  should  be  sought, 
who  will  check  the  bleeding  by  cauterizing  with  hot  iron, 
nitrate  of  silver,  or  by  employing  serrefines,  or  by  a 
ligature,  etc. 

After  the  bleeding  is  checked,  a  soft  dry  compress  is 
placed  on  the  leech-bites  j  if  inflammation  sets  in,  com- 
presses of  lead- water  are  used. 

In  the  case  of  a  leech  having  been  swallowed,  the 
patient  should  drink  a  great  deal  of  salt-water.  If  a  leech 
has  crawled  into  a  cavity  (nose,  anus),  injections  of  strong 
salt-water  should  be  used.  Leeches  which  have  been  used 
in  contagious  diseases  (typhus,  cholera,  small-pox,  syphilis, 
etc.),  ought  not  to  be  preserved. 

*Scraped  charpie  is  obtaiued  by  scraping  with  a  sharp  knife  over  a  tightly 
spanutd  strip  of  liuen. 


258  MISCELLANEOUS. 


VIII.—MISCELLANEOUS. 

Temperature  of  the  hody.  The  appreciation  of  the 
temperature  of  the  body  has  attained  such  an  importance 
for  diagnosis  and  prognosis,  and  even  for  therapeutics, 
that  it  can  scarcely  be  dispensed  with  in  acute  diseases  of 
a  serious  character;  nor  is  its  importance  much  less  in 
chronic  diseases.  Where  the  physician  lives  at  a  great 
distance,  he  will  sometimes  commission  a  member  of  the 
family  to  measure  the  temperature.  Besides,  it  may  be 
sometimes  useful  for  unprofessional  persons,  in  the  event  ot 
sudden  attacks  of  illness,  to  have  a  criterion  of  the  more 
or  less  serious  character  of  the  disease  afforded  by  the 
measurement  of  the  bodily  temperature.  It  is  to  be  hoped 
that  in  the  course  of  time  every  educated  family  will  be  in 
possession  of  a  thermometer  adapted  for  this  end.  Until 
then,  the  physician  must  leave  behind  such  a  thermometer 
in  all  cases  wherein  he  wishes  to  have  the  temperature 
measured  during  his  absence.  The  heat  is  generally  tested 
in  the  armpit ;  in  the  case  of  little  children,  in  the  rectum. 
In  the  former,  all  sweat  is  first  wiped  off,  the  bulb  of  the 
thermometer  is  warmed  for  some  seconds  in  the  hand,  and 
then  placed  deeply  into  the  axilla.  In  order  to  close  the 
armpit  more  surely  and  tightly,  the  arm  should  be  well 
pressed  to  the  side,  but  somewhat  to  the  front.  The  bulb 
should  be  everywhere  close  to  the  skin :  articles  of  clothing, 
therefore,  must  be  prevented  from  interposing.  If  the 
patient  is  fidgety,  feeble,  or  unconscious,  the  arm  should^ 
be  held  securely  in  its  proper  position,  lest  the  test  fail. 
The  thermometer  is  allowed  to  remain  in  its  position  for  ten 
to  fifteen  minutes  ;  then  the  degrees  are  read,  if  necessary, 
by  help  of  a  light,  and  are  noted  down  immediately^  stating 


MISCELLANEOUS.  259 

the  day,  hour,  and  time,  used  for  testing.  In  testing  the 
temperature  in  the  rectum,  the  bulb  is  introduced  into  the 
rectum  one  to  one- and  one-half  inches,  and  is  allowed  to 
remain  for  five  to  six  minutes ;  for  here  the  instrument 
is  better  enclosed,  and  the  maximum  heat  is  consequently 
sooner  ascertained.  Care  must  be  taken  to  hold  both  in- 
strument and  child  carefully,  lest  the  former  be  pressed 
out  or  broken  by  a  violent  movement  of  the  patient,  and  the 
latter  be  injured. 

The  thermometers  used  for  measuring  the  tempera- 
ture of  the  body  are  generally  centigrade ;  the  single 
degrees  are  subdivided  in  fifths  or  tenths,  which  are  also 
noted  down.  (5^  C.  are  like  4^  K. ;  C  =  i  (F-32),  or 
F=  ^  C+32.) 

Subcutaneous  or  hypodermic  injections.  These  are  some- 
times left  to  be  done  by  the  attendants.  In  such  cases  the 
prescription  of  the  physician  must  not  be  transgressed  with 
regard  to  number  and  quantity.  The  syringe  is  provided 
by  the  physician. 

The  tube  is  filled  by  drawing  the  piston  up.  Then  the 
syringe  is  held  up,  and  the  piston  pressed  forward,  until 
some  of  the  liquid  is  expelled.  This  is  done  to  prevent 
injection  of  air.  The  quantity  is  either  measured  by  a 
screw,  or  else  so  much  of  the  fluid  is  expelled  beforehand 
that  only  the  prescribed  quantity  is  left.  Raise  then, 
with  the  left  hand,  a  fold  of  the  skin,  at  the  place  pointed 
out  by  the  physician,  and  pierce  the  needle  of  the  syringe 
through  the  skin  at  the  bottom  of  this  fold  parallel  to  the 
surface  of  the  body,  and  parallel  to  the  longitudinal  direc- 
tion of  the  fold.  That  the  skin  is  pierced,  may  be  inferred 
from  the  sensation  of  less  resistance  offered  by  the  loose 
cellular  tissue  of  the  dermis.  Now  the  fold  is  let  loose, 
the  piston  is  pressed  slowly  forward,  and  the  contents  of 


260  NURSING  DURING  THE   LAST  MOMENTS. 

the  syringe  are  thus  injected  under  the  skin.  Then  a 
finger  is  placed  on  the  opening,  and  the  needle  drawn 
back  slowly.  The  sac  formed  by  the  injection  may  be 
distributed  by  gentle  rubbing.  Clean  the  syringe  with 
pure  water,  blow  the  water  out  of  the  tube  of  the  needle, 
and,  in  order  to  prevent  rusting,  put  a  fine  silver-wire  or  a 
bristle  through  the  tube. 

Freserving  excrements.  If  the  physician  orders  the 
preserving  of  excrements,  they  should  be  received  in  pure 
vessels,  and  kept  free  from  all  foreign  matter.  Bed-pans 
are  very  useful  for  feeble  patients,  in  order  to  preserve 
cleanliness.  Expectorations  should  be  preserved  in  a  glass, 
a  third  of  which  is  filled  with  pure  water. 


IX.— NURSING  DURING  THE  LAST  MOMENTS. 

The  duties  of  nursing  last  until  the  moment  of  death, 
and  even  beyond  it.  Here  a  few  words  of  caution  may 
not  be  out  of  place.  First,  the  attendance  to  the  bodily 
"Welfare  of  the  dying  should  not  be  neglected.  It  is  in- 
human to  render  the  last  moments  of  dying  persons,  at 
least  of  those  who  retain  consciousness,  still  more  hard  by 
giving  way  entirely  to  sorrow,  and  by  neglecting  to  clean 
them,  from  motives  of  mistaken  delicacy,  or  to  administer 
the  prescribed  medicines.  The  dying  are  often  much 
more  molested  by  the  noise,  screaming,  and  weeping  of 
those  who  surround  them,  than  by  the  small  trouble 
occasioned  by  medicines,  drinks,  etc.  The  administration 
of  medicines  might  perhaps  be  dispensed  with,  unless  pre- 
scribed to  counteract  the  approaching  paralysis  j  but  it  is 
of  the  utmost  importance  to  alleviate  that  tormenting 
dryness  of  the  mouth  and  palate  caused  by  the  difficiUt 


NURSING   DURING   THE   LAST   MOMENTS.  261 

breathing  from  the  open  mouth,  by  giving  spoonfuls  of 
water,  or  water  with  a  little  wine,  or  even  only  by  moisten- 
ing the  lips  and  the  tongue.  Admit  as  much  fresh  air  as 
possible  into  the  room,  remove  all  unnecessary  persons, 
that  is,  strangers.  Nobody  should  be  allowed  to  throw  him- 
self over  the  dying.  But,  whilst  urging  the  utmost  control 
in  the  expressions  of  sorrow,  we  by  no  means  advocate 
want  of  feeling.  That  foolish  excitement  and  loud  scream- 
ing, which,  after  all,  is  indeed  not  very  Christian-like,  is  all 
we  deprecate.  Words  of  consolation,  short  prayers,  are 
calculated  to  alleviate  the  last  trying  moments  ;  whilst  loud 
wailing,  running  hither  and  thither,  and  still  more,  crying 
into  the  ears  of  the  dying,  are  calculated  only  to  disturb 
and  harass  them.  An  abominable  custom  is  practised  in 
some  districts,  namely,  that  of  drawing  the  pillow  from 
under  the  head  of  the  dying  person,  in  order  to  shorten 
the  mortal  struggle.  This  is  done,  of  course,  out  of  com- 
passion, but  it  is  a  very  false  one ;  and  I  suspect  that  there 
is  in  such  inhumanity,  really,  although  unconsciously,  more 
of  sympathy  for  the  survivors,  than  of  compassion  for  the 
dying  person  himself. 

After  death,  the  corpse  should  remain  covered  in  bed  for 
twenty -four  hours,  and  should  not  be  undressed  and  washed 
before.  But  where  it  is  absolutely  necessary  that  the 
dressing  and  washing  should  be  done  before  that  time,  it 
should  not  be  done  before  the  corpse  has  become  cold ; 
and  even  then  it  should  remain  in  the  bed.  There  is  no 
objection  to  closing  the  eyes ;  but  it  is  a  great  abuse  to 
bind  up  the  mouth  tightly,  as  is  often  done  immediately  after 
death.  It  should  rather  be  always  remembered  that  there 
is  a  possibility  of  death  being  only  apparent,  and  then  the 
bandaging  of  the  mouth  would  prevent  the  return  of 
breathing. 


262  NURSING  DUKIXa  THE   LAST   MOMENTS. 

If  possible,  the  corpse  should  not  be  left  during  the  first 
twenty-four  hours  without  being  watched.  Wakes  in  the 
proper  sense  are  not  necessary  in  general,  and  they  lead 
to  many  abuses ;  yet  the  corpse  should  be  watched,  or  at 
least  looked  at  from  time  to  time,  until  certain  signs  of 
death  are  established. 

A.  M.  D.  a. 


THE  END. 


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